The Senedd met in the Chamber and by video-conference at 13:30 with the Llywydd (Elin Jones) in the Chair.

Statement by the Llywydd

Good afternoon, and, if I could call the Senedd to order, I'm sure that, before we begin our work with questions to the First Minister this afternoon, we'd like to take a few seconds to reflect on what's happening in the middle east, and that we have all been horrified by these most recent events. Therefore, to reflect on that, I will now invite all the party leaders to contribute their thoughts on these events. First of all, the First Minister.

Mark Drakeford AC: Llywydd, diolch yn fawr. This weekend brought a terrible escalation in the violence against Israel, and this week has seen that violence continue and widen. The events are shocking and appalling. As we sit here in this Chamber, children, older people and the civilian population in Israel and in Gaza are in vivid fear for their lives, while grieving for those already lost. And the impact of those events is not confined to the streets of Israel and Gaza; they have a real impact here in Wales, in our own communities, and our thoughts are with all of those caught up in this enduring cycle of violence. We condemn of course the perpetrators of these attacks, which have taken the lives of so many innocent civilians. But condemnation alone is not enough. A two-state solution is the policy of the UK Government and of the United Nations. Beyond the horror of the coming days, the international community must come together to work again for a lasting peace, a secure peace, a peace that reaches into the everyday lives of the Israeli and the Palestinian people. And hard as it is, and made harder yet by the war that continues to unfold, the only path to a better future has to be a path of peace.

The leader of the Welsh Conservatives, Andrew R.T. Davies.

Andrew R.T. Davies AC: Thank you, Presiding Officer. I think many of us, when we woke up on Saturday morning and we saw the images coming from Israel, were aghast at what was unfolding before us. We all know that that part of the world is a very volatile place, but to see the activities of the terrorist organisation Hamas break through the border and actually murder women, children and old people in their homes and in their community settings is something that we all deplore, and rightly so. And we must all support Israel's right of defence and making sure that its international borders are recognised and, ultimately, protected. What we also must remember is that, as the First Minister highlighted, as we sit in this Chamber here today, there are people cowering in basements, in community settings because missiles and rockets are going off indiscriminately, both in Israel and the Gaza Strip.
And it is something that we as a country, the United Kingdom, and the international community, and us here in Wales, must redouble our efforts on to bring peace to the communities that live in that part of the world, because without peace in the middle east, we do not have peace across the globe. And to see the suffering, to see the anguish, and to see the horror must fill us all to make sure that we double our efforts to bring that peace, a lasting peace, to that part of the globe. And the one image I would ask all Members to reflect on is the image on the front page of The Times today of a family of three young children, a father and a mother, who were slaughtered—who were slaughtered—on the weekend because they happened to be Israelis. That is something that none of us—none of us—should stand by and condone, and we must make sure that we redouble our efforts to support Israel's right to self-determination, to protect its borders. We support the civilians in the Palestinian community who abhor what Hamas is doing, supposedly in their name, which I would argue is not being done in their name, and make sure that we stand shoulder to shoulder where this violence is inflicting such multiple misery and suffering, so that we can enjoy the peace that the First Minister has talked about, and the peace that we all want to see.

The leader of Plaid Cymru, Rhun ap Iorwerth.

Rhun ap Iorwerth AC: The events over the past few days in the middle east have shaken us all. We today think about everyone who has been affected directly by this, about the lives that have been lost, and we think of everyone of Israeli and Palestinian heritage in Wales who has been suffering while watching the events of the past few days. We in Plaid Cymru and everyone in the Senedd can always unite in our condemnation of violence against our fellow man. We condemn the attacks by Hamas, and today we urge the international community to work together swiftly to persuade the relevant powers to introduce a ceasefire to allow the release of those held in Gaza against their will.
We also believe that the way that the Israeli Government has placed Gaza under siege, ceasing water and energy supplies, is impossible to justify. Ordinary Palestinians, of course, have been let down by the international community and have suffered years of violence and injustice. Now people on both sides of the border are losing their lives again in heartbreaking circumstances. Worsening the violence is not the solution. The indiscriminate attacks on citizens will do nothing to alleviate tensions. The suffering facing ordinary people from all beliefs in this violent conflict have touched us all, and our thoughts are with each and every one of them in another dark chapter in the history of the region.

The leader of the Welsh Liberal Democrats, Jane Dodds.

Jane Dodds AS: Thank you very much for the opportunity to say a few brief words.

Jane Dodds AS: Our thoughts are with all those whose lives have been impacted by this tragic violence. We fully condemn the terrorism of Hamas and Islamic jihad. I echo the comments of Layla Moran, the Liberal Democrat spokesperson on foreign affairs, herself of Palestinian descent, who said that civilians must be protected, and that we are especially horrified to hear about hostage taking, and that we condemn all of the violence. This is sadly a significant escalation. The United Nations said:
'In conflict, civilians always pay the highest price. War is not the answer. We need peace.'
To finish, I hope and pray that all efforts from everyone, everywhere will concentrate on negotiations, peace, safety and protection of all caught up in this horrendous conflict. Diolch yn fawr iawn.

I thank the party leaders. Each of them has made a plea for peace in the middle east this afternoon, reflecting all of our views, I'm sure, in that regard.

1. Questions to the First Minister

We will now move on to our first item, which is questions to the First Minister, and the first question is from Luke Fletcher.

The Impact of Co-operatively Owned Businesses

Luke Fletcher AS: 1. What assessment has the Government made of the impact of co-operatively owned businesses on the Welsh economy? OQ60037

Mark Drakeford AC: Llywydd, the Welsh Government has long supported the co-operative sector, including dedicated development funding. The latest 'Co-operative and Mutual Economy 2023' report shows further growth, with over 520 co-operatively owned businesses in Wales.

Luke Fletcher AS: Thank you for that reply, First Minister.

Luke Fletcher AS: The Government is, of course, poised to meet its goal of doubling the number of employee-owned businesses in Wales, and that is very welcome. Within the wider context of the Welsh economy, recent research from Co-operatives UK shows that Welsh co-operatives have the lowest annual turnover in the UK, accounting for just 0.6 per cent of Welsh GDP. Now, I would argue that we need to go beyond just doubling the number of co-operatives in order to scale up our ambitions in the sector, and that means, of course, proactive work from Government, with the finance to back it up. Does the First Minister agree with me and does he think that there are currently enough resources allocated to foster and expand the sector, especially given that the Development Bank of Wales doesn't have a specific fund for co-operatives?

Mark Drakeford AC: Well, I thank Luke Fletcher for that further set of questions. Llywydd, I read the Member's article in theMorning Star recently, and it sets out the views he has expressed this afternoon and develops them further. Thank you to him for his recognition that we are very likely now to reach that initial target of doubling the number of co-operatively owned businesses. But, I agree with him that there is more that can and should be done, and there is some good news in that, in that the rate of co-operative business creation in Wales—co-operative start-ups—is the highest in the whole of the United Kingdom, with a greater number of new co-operative businesses created here than in Scotland, England or Northern Ireland in comparison with the size of our population. There are funds that are dedicated to supporting the sector, and while there may not be a specific fund within the Development Bank of Wales, the £25 million Welsh management succession fund means that when businesses are in transition, we are able to support employees or managers looking to buy out those buildings and turn them into a co-operative model. We have expertise and financial capacity there to help them to do so.

Paul Davies AC: Last week, I visited First Milk creamery in Haverfordwest in my constituency with my colleague Sam Kurtz, and, as you know, First Minister, First Milk is a co-operative business owned by farmers who follow regenerative farming practices. And they really are doing some important work, such as moving carbon from the atmosphere and sequestering it into the soil. They're also investing in energy-efficient processes and equipment, and are seeking renewable energy options for milk processing and transportation. They really are at the cutting edge of innovative modern farming, as well as producing high-quality products such as cheese. And, First Minister, it's well documented that you love cheese, so can I invite you to come to Pembrokeshire to visit First Milk and learn more about what it does and how it operates?

Mark Drakeford AC: Well, I thank Paul Davies both for what he said and for the invitation. Of course, there's a long history of co-operative endeavour in the farming sector and in the milk sector in particular. And I'd like to congratulate those who participate in the First Milk creamery endeavour for the way in which, as Paul Davies has said, they have put themselves at that advance guard of developments that are going on in the sector, and adding value to the product that they produce in a way that we know has to be the future of the industry here in Wales. Any invitation that has cheese attached to it is bound to command a certain priority in the diary, so we will look to see whether we can come back to the Member on that. [Laughter.]

Vikki Howells AC: First Minister, with the programme for government containing the commitment to double the number of employee-owned businesses this Senedd term, I was pleased to see the update from the Minister for Economy in June that there are now 63 employee-owned businesses in Wales, more than the 37 at the start of the term and well on the way to that target of 74. We know that employee-owned businesses align with the current national well-being outcomes and mirror the 'A Prosperous Wales' fair work agenda. So, First Minister, how else can Welsh Government engage with businesses, workers and the sector to grow the number of employee-owned enterprises, meet that target and further develop the Welsh economy?

Mark Drakeford AC: Llywydd, I thank Vikki Howells for that and I agree with the point she made about the wider benefits of the co-operative model. And I think the figures today are even a little better than the ones that she quoted from back in June, because we now have 65 employee-owned businesses across Wales. There are a further six that are in the latter legal stages of transitioning to that model, and there are a further four already in the pipeline. So, as Luke Fletcher said and as Vikki Howells confirmed, we are well on our way to that target set out at the start of this term.
Llywydd, in addition to the help available through the Development Bank of Wales, the Welsh Government provides specific funding to the organisationCwmpasto promote the benefits and the development of employee ownership in Wales. And that means that we are able to provide intensive support to those businesses that embark upon that transition to becoming an employee-owned business. The funding is designed to create 20 employee-owner champions, so that there is a visibility to the effort that's being made across Wales, and then to create events where the benefits—the wider benefits as well as the economic benefits, as Vikki Howells said—can be promoted to other businesses that might have an interest in exploring the same model in the future.

The Effectiveness of Stroke Services

Mabon ap Gwynfor AS: 2. Will the First Minister provide an update on the effectiveness of stroke services? OQ60042

Mark Drakeford AC: I thank Mabon ap Gwynfor for that question. Newly launched stroke guidance from the Royal College of Physicians calls for stroke services to be organised regionally. The Welsh Government has adopted this model because it will deliver the most effective services.

Mabon ap Gwynfor AS: I thank the First Minister for that response. On that point of regional stroke services, given the rural nature of Wales and the fact that 80 per cent of stroke sufferers are driven to hospital rather than relying on an ambulance, does the First Minister believe that centralising stroke services is the best way ahead?

Mark Drakeford AC: Of course I acknowledge the point made by the Member about the rural nature of Wales—a country where a great number of people travel to receive their services. The intention is to develop four regional stroke centres in Wales, and through the process of developing them, to take into account Wales's rural nature. That's part of the work that the Minister has started, work that is being led by Dr Shakeel Ahmad, who is one of the best people in Wales, and across the UK, to help us in developing this work. I know that the group that is working on the plan for the regional centres, the network that we have, is aware of the points that were raised by the Member.

Sam Rowlands AS: Thank you to Mabon ap Gwynfor for raising this important issue here today. I certainly support the premise of Mabon ap Gwynfor’s question, because, First Minister, you’ll know that, by 2035, stroke incidence is set to increase by 120 per cent, a significant increase in the level of stroke incidence in the UK. This point about proximity of services becomes therefore even more important, because more people will need to access those important speech therapy and physiotherapy-type services. So I just wonder, as this work takes place, what assurances you can give my residents in north Wales—as you know, a rural part of the world—that both expertise and access to expertise, but also the proximity of those services, are properly considered during the change process.

Mark Drakeford AC: I thank Sam Rowlands for that. I think in his question there was an important distinction that we need to try to make sure we communicate to people. There will be services that are so specialist in their nature that they can only safely and effectively be provided when you concentrate expertise in particular centres. Thrombectomy is a new technique that allows very skilled individuals to withdraw the clot from the brain that has caused the stroke in the first place, and can be very effective in between 10 per cent and 15 per cent of stroke cases. You can only do that in places where people have the expertise to do it given the inherent risks in an operation of that sort. But then—and this is the point I think the Member was making—when people are in recovery and in rehabilitation, those are services that have to be provided much closer to people's homes. That's the explanation we have to develop so that we can give people the confidence that they need that, when they need that really expert care, it will be available to them, provided by people who do this every day, and then, when that expert part of their care is completed, the recovery work and the rehabilitation work will be provided much closer to home.

Questions Without Notice from the Party Leaders

Questions now from party leaders. Leader of the Welsh Conservatives, Andrew R.T. Davies.

Andrew R.T. Davies AC: Thank you, Presiding Officer. First Minister, the Labour Party are meeting in Liverpool today. The dear leader is just about to take to his feet, at 2 o'clock, as I understand it. I appreciate that you are responding to First Minister's questions on behalf of the Government. Before the conference season kicked in, Keir Starmer used to say, 'For what we would do in Government in Westminster, look to Wales as a blueprint'. Last week he was unable to say that in his interview on the BBC. But one of the terms he's going to use at the speech he gives this afternoon is that Labour are the party of the healers. When you look at the health record here in Wales, one in four people are on a waiting list and nearly 28,000 are waiting two years or more. Do you think he's misleading the public when he talks about being the party of the healers when he looks at your record?

Mark Drakeford AC: Of course, I always thank the leader of the opposition for drawing attention to events at the Labour Party conference—a highly successful conference, a very, very different conference to the despair and desperation of the week before. I'm very proud of the fact that the leader of the Labour Party looks to Wales for examples of what Labour can achieve in power, and he has been busy doing that in Liverpool over the last few days. The next Labour Government will be a government that will need to heal many, many of the rifts in the United Kingdom that are the product of 13 years of his party in power. And in that, he will no doubt be reminding people in England that while waiting lists in Wales have grown by 1.9 per cent in the last 12 months, in England they have risen by 10.7 per cent over that same period.

Andrew R.T. Davies AC: First Minister, in Wales, one in four people are on a waiting list, or 25 per cent of the population; in England it's 14 per cent. In England, there are just over 250 people waiting two years or more; in Wales, as I said, there are 28,000 people waiting. I notice you didn't offer any solutions or help for justification to Keir Starmer for what you're doing here in Wales, because you know full well that the record of the Welsh Labour Government here is so atrocious.
He's also going to call the Labour Party the party of the builders. But when you look at the house building programmes that successive Labour Governments have delivered here in Wales, you haven't delivered half the quantity of housing that is required here in Wales, and that's why so many people find their inability to put a roof over their head—leave alone the transport Minister's ban on road-building projects here in Wales to develop the economy. So how on earth can the Labour leader in London call them the party of the house builder, when here in Wales, if you take your blueprint, you fail to deliver even half the number of houses that are required?

Mark Drakeford AC: Well, Llywydd, for a man who began with a reference to healing, his contribution is hardly designed, is it, to bring people together and to make people feel that they are part of a single United Kingdom. I will not follow him down his road of trying, always, to split people off, to be divisive in the way that he portrays the United Kingdom.
But let me just answer one or two of the specific points that he makes. Because if he thinks for a moment that the record of his Government on house building is one that we should follow here in Wales, I'd be absolutely astonished. How many by-elections has his party lost in England because of his party's house building programme? How many twists and turns have there been in the party's house building programme in order to try to satisfy those people on the Conservative back benches who want to see houses built, and those people on the back benches of the Conservative Party who are determined that a house will never be built in their own constituency? Here in Wales, we press ahead with our house building programme with the 20,000 new houses for social rent that we will create here—far, far more than his party will ever create in England.
And as far as the health service is concerned, I'm happy, any single day, to put our record in front of people in Wales and ask them who will they trust with the future of the health service. And I can tell you this at least: it won't be his party.

Andrew R.T. Davies AC: First Minister, I've highlighted the health service, I've highlighted the lack of building here in Wales. One thing that you and I have debated over this Chamber floor over many weeks is, obviously, the Government's policy on the 20 mph restrictions that have been brought in.Keir Starmer, when he was interviewed on the BBC, said that it wasn't a default speed limit. Then, when he was interviewed on ITV, he called it a blanket speed limit.Did you sit down with the leader of the Labour Party, just as you've tried to lecture us on this side of the table, and ultimately tell him what your policy is, which is a policy that actually will not drive down the casualty numbers here in Wales and will harm economic productivity? Ultimately, your own leader in London is distancing himself from your terminology and, ultimately, is not supporting the policy that you have promoted over the last six months and have implemented here in Wales from the middle of September.

Mark Drakeford AC: Well, Llywydd, I am used to some flights of fantasy by the leader of the opposition, but this afternoon he has become completely unmoored from any sense of reality on this matter. Of course—of course—slower speed limits prevent accidents. There's evidence from absolutely—[Interruption.] I think, Llywydd, the leader of the opposition has ample opportunity to put his questions without needing to interrupt me immediately after I start to correct him for his many, many errors on this matter.
Right across the world, the evidence is clear: where speed limits are reduced accidents fall, lives are saved and people do not suffer the injuries that they do suffer when people drive at 30 mph in built-up residential areas. That is true in London, it is true in Edinburgh, it is true in Spain—it is true wherever objective evidence is created.
I thought of this, Llywydd, as I drove to Labour's conference in Liverpool, passing all of those 20 mph streets; every residential street you pass is 20 mph, as it was in Chester when I drove near the border there—20 mph speed limits in residential areas are happening everywhere. Here in Wales, we will see the benefit of it, and we'll see the benefit of it in the most important way; lives will be saved, accidents that otherwise would have taken place will be avoided, and the price we're asked to pay is a very small one of driving a little more slowly in those places where those accidents are most likely to happen. Our fellow citizens, unlike his party, are showing in the way that they are behaving that they understand that and they are abiding by it.

Leader of Plaid Cymru, Rhun ap Iorwerth.

Rhun ap Iorwerth AC: Diolch, Llywydd. The party conference season is a great opportunity for parties to spell out how they'll fight for what is right for Wales. Not long after I'd set out my vision for reforming to build in Aberystwyth, Labour's shadow Secretary of State for Wales was on the airwaves in Liverpool outlining her vision. There was reference, no surprise, to the high speed 2 line fiasco that came to a head in the Conservative conference, but it was thoroughly depressing to read the headline afterwards: 'Labour can't commit to HS2 funding share, MP says'.
Labour says we'll have an HS2 inquiry if it wins power in Westminster, but we in Wales are owed a cheque, not the kicking of a can down the tracks at the expense of our transport networks. The First Minister himself says that Wales is being cheated over this issue, but Labour won't take action. When the boss of Unite accused Labour of being too timid, I wonder whether the First Minister believes that she was referencing Labour's attitude towards HS2 in Wales.

Mark Drakeford AC: First of all, Llywydd, let me say again that it is the view of the Welsh Government, as it is the view of parties across this Chamber, that Wales deserves our share of the funding that has been invested in HS2. That should have been the case from the beginning, had the Treasury not decided to interpret the rules in a way that no-one else is able to understand.
An incoming Labour Government, as I've explained many times, now, on the floor of the Senedd, is going to inherit an economic set of circumstances that means that no responsible party is going, in the run-up to an election, to be offering to sign cheques for the very, very many causes that will be put to that Government, all of which, I'm sure, will have merit. You have to allow an incoming Government, if there is to be a Labour Government, to take stock of what it has inherited, to do the hard work of putting the economy back on track and then to make those investments in our future, including rail investment here in Wales, that will allow that prosperity to continue. That is how the Labour Party is approaching the serious business of Government. We will continue to make the case, not simply on HS2, but on all those other matters that are important to us here in Wales, and when we have that Labour Government, we will have an inside track and a sympathetic Government to the needs of Wales to make that case.

Rhun ap Iorwerth AC: But it's exactly the same economic circumstances in which you say the Conservatives should be paying consequentials. You're right, the Government is stressing time and time again that Wales is owed this money. I'm grateful for the response I've received from the Counsel General today to a question I asked, asking:
'What legal avenues are available to the Welsh Government to challenge the UK Government's decision to classify the HS2 rail programme as an "England and Wales" project?'
And in that response, as well as saying that, yes, as we would argue, the decision to cancel the Birmingham to Manchester HS2 routes makes the case even clearer that HS2 is an England-only project, the Counsel General says that Welsh Government is considering all options available, including legal avenues, to challenge the decision to classify HS2 as an England and Wales project. Given the Counsel General's response, could we therefore assume that if Keir Starmer does become Prime Minister, the Labour Government in Wales is also willing to launch a legal challenge against the Labour Government at Westminster?

Mark Drakeford AC: Well, I'm afraid, there are so many ifs and buts in that question that it's impossible to give him a sensible answer. The answer that was given to the question is the right question to ask in the current circumstances: of course, we continue to explore all the avenues that are available to us. Some of those may be legal. There are the inter-governmental relations courses of actions that we can use. That is the current state of play. Nobody sensible is able to offer the leader of Plaid Cymru a set of options for what might pertain in some future set of circumstances that nobody here can properly anticipate.

Rhun ap Iorwerth AC: The point is this: Labour can't have it both ways. They can't, on one hand, say they're prepared to launch a legal challenge, perhaps, against a Conservative Government, and say they're not willing to consider launching a legal challenge against a Labour Government on exactly the same issue. They can't say on one hand that the Conservatives should pay up, but Labour, with exactly the same purse strings, would be right to consider what priorities they have in front of them.
We know that we can't trust the Tories in Government. The commitment to electrify the north Wales line unraveled as quickly as it took the Prime Minister to find the fag packet to scribble the promise on in the first place. But does the First Minister agree with me that there's a real risk here that what we're seeing is that a Labour incoming Government would do exactly the same thing as the Tories, in talking a good game, but not acting in the best interests of economic justice for Wales. Plaid Cymru will always stand up for fairness for Wales over HS2.

Mark Drakeford AC: Well, Llywydd, let me explain this to the leader of Plaid Cymru: people on these benches will be working as hard as we can to secure that Labour Government. He will not lift a single finger to do so. In fact, in many parts of Wales, he will be doing his very best to frustrate the possibility of that Labour Government. You will hardly expect us to take lectures from him on what a Labour Government will do when we will work hard every day to create it and he will do nothing at all to bring it about.

E-cigarettes in Public Places

Ken Skates AC: 3. What is the Welsh Government's policy on the use of e-cigarettes in public places? OQ60068

Mark Drakeford AC: I thank Ken Skates for that, Llywydd. The Welsh Government’s policy is to discourage the use of e-cigarettes in public places. The failure of the Public Health (Wales) Bill 2016 means that no powers are available to the Senedd to enforce such a policy.

Ken Skates AC: Thank you, First Minister. Later this afternoon, the health Minister will deliver a statement on planning for the NHS in the next 10 years, but tragically, we've lost almost a decade of opportunity to protect young people from the harmful effects of vaping, and that's as a direct result, as you outlined, of the public health Bill falling at the final stage back in 2016. I remember that occasion very well; I'm sure you do as well, as you were the Minister at the time in charge of that particular piece of legislation.
First Minister, would you agree that it's incumbent on all Members in this Chamber to support preventative healthcare measures designed to protect people, especially the most vulnerable in society?

Mark Drakeford AC: Llywydd, I thank Ken Skates for that. I answered a question from a Conservative Member on the floor of the Senedd only last week about the importance of preventative healthcare. And here, in this Senedd, we have to face up to the fact that there was an opportunity for this Senedd to take that preventative action and that opportunity was failed. The 2016 Bill would've brought the use of e-cigarettes into line with the use of other tobacco products and there were amendments passed to it during its earlier stages to provide new protections in places where children were most likely to be present. As was warned at the time, the use of e-cigarettes has now spread into those younger aged cohorts. The US Surgeon General issued advice in America recently to say that aggressive steps were now needed to protect our children. The World Health Organization last month published advice on banning smoking and vaping in schools to protect young people. It said that the tobacco industry relentlessly targets young people with tobacco and nicotine products, resulting in e-cigartette use increasing and nine out of 10 smokers starting before the age of 18.
Llywydd, I welcome what the Prime Minister said at the Conservative Party conference last week—that the UK Government now intends to take the actions that we could have taken here in 2016. We've lost ground in the meantime. There are children addicted to nicotine today who would've been saved from that addiction had this Senedd taken the action that was available to it. But we can't put that piece of history right; we can make a difference in the future. The proposals that were made by the Prime Minister are ones that we will support, and we will align ourselves with the consultation that we expect the UK Government to develop, to make sure that we can now at last take the actions that will prevent our children falling victims to the deliberate attempt to ensnare them in nicotine addiction.

Darren Millar AC: First Minister, nicotine vaping is substantially less harmful to people's health than smoking and is one of the most effective tools for helping people to quit the smoking habit. We know that more than three quarters of people who use e-cigarettes as adults use them as a tool to quit smoking, and that is why we have seen the smoking rates in Wales fall from 20 per cent just eight years ago to around 13 per cent today. I agree with you that we need to ban disposable vapes, which are very often the ones that young people are accessing, and we need to address the appalling marketing that is done by irresponsible businesses and companies to try and get vapes into the hands of young people. But given the health benefits that many people in Wales are now accruing as a result of using e-cigarettes in order to quit the smoking habit, what work is the Welsh Government doing to make sure that more people are able to use e-cigarettes, as part of the NHS smoking cessation services here in Wales?

Mark Drakeford AC: Llywydd, there are a number of things in what the Member said that I agree with. I agree with him about the pernicious effect of disposable e-cigarettes, with 1.3 million thrown away every week in the United Kingdom, accumulating to 10 tonnes—10 tonnes—of lithium every year. So, I agree with him on a number of the points that he made. As to whether e-cigarettes are a significant contribution to people quitting smoking, I think the evidence is a good deal more equivocal than he would suggest. Most people who use e-cigarettes are dual users; they use e-cigartettes and they use conventional cigarettes and that does not reduce the harm of cigarettes themselves. A very small number—[Interruption.] Well, the evidence is not—the Member says to me, 'Oh, they're reducing', but it doesn't work like that. If it did, maybe he would be right, but the evidence is not that. People use the two and they use them both and they continue to use them both and they don't reduce smoking in the way that he said. And cigarette use in Wales was reducing far before e-cigarettes were ever available. The causal effect that he seeks to draw between the availability of e-cigarettes and the reductions in smoking bears no examination whatsoever.
Now, there are different views. There are different views and we can debate them, of course, and my view, certainly, Ithink, will be different from his. But experts disagree as well. In Australia, for example, Llywydd, the only way you can get an e-cigarette is by prescription—you can't buy them in shops—only through a medical prescription as part of a supervised attempt to give up smoking are they available. I would be attracted to that idea myself. What does the Australian Government say on its website? 'Are e-cigarettes safe?' it says. Answer: 'No'. They're not safe. It goes on to say,
'Can e-cigarettes help you to quit smoking?'
There is insufficient evidence, it says,
'to promote the use of e-cigarettes for smoking cessation.'
So,I'm simply saying to the Member—[Interruption.]I'm saying to the Member there are different views—

Darren Millar, theFirst Minister is attempting to answer your question.

Mark Drakeford AC: I'm trying to make—well, it wouldn't be difficult—a slightly more subtle point than the Member himself is making. I am simply saying to him that this continues to be a contested area, a contested area not where lay opinion simply differs, but where there are significant differences of views between medical experts. In those circumstances, I think some of the claims he made earlier are significantly overstated.

The Economy of South Wales West

Tom Giffard AS: 4. How does the Welsh Government plan to grow the economy in South Wales West? OQ60074

Mark Drakeford AC: Llywydd, investment in skills, infrastructure, direct support for firms with potential to grow and mobilising partnerships with others will form part of a plan for economic growth in the Member’s region.

Tom Giffard AS: A key measure that many of us will use to assess the strength of an economy is the health of their local high street, and, unfortunately, in Mumbles in my region of South Wales West, an area that has traditionally punched above its weight when it comes to the presence of small businesses, we've seen a recent wave of business closures. These include shops like The Choice Is Yours, the local Barclays branch as well as pubs and restaurants like the Dark Horse and Cakes & Ale. That sees a wider problem reflected across Wales. According to data from the real estate analysts Altus Group and reported by the BBC, over the six months to June this year, Wales lost the greatest number of pubs of any part of UK as a whole, with 52 shutting down.
Unfortunately business rates in Wales remain higher than in the rest of Great Britain. Figures from the Welsh Retail Consortium show that just over one in six shops are empty, the second worst rate in the UK, and those same figures show that Wales suffered a bigger decrease in footfall last quarter than England did as well. And the Federation of Small Businesses national chairman has stated that the business rates system is what's contributing to empty shops. He said that the tax has materially damaged companies across the country. Clearly, there's a specific Welsh Government policy problem given some of the statistics I read out there for the First Minister. So, what steps are you taking to relieve the burden on our local high-street businesses and ensure that more closures like the ones we've seen recently in Mumbles aren't more commonplace?

Mark Drakeford AC: Llywydd, there's no doubt that there is a challenge for the high street in every part of the United Kingdom, and there are closures on retail high streets in every part of the United Kingdom. That, I think, is just a fact of the matter. Weekday footfall, particularly, reduced in retail destinations across the United Kingdom in the last month for which figures are available. Where the Member is quite wrong—quite wrong—is to try to tie that UK-wide pattern to rate relief here in Wales, because, in fact, far from being the position that he outlined, rate relief reaches more businesses in Wales than in any other part of the United Kingdom, and certainly far more than in England, no doubt the country to which he would refer. We provide 75 per cent relief for retail, leisure and hospitality businesses again this year, the fourth year in which we've provided generous relief for these sectors. We do so in a way that reflects the rateable values here in Wales and that means far more businesses, especially small businesses, benefit, and not just that, but they benefit because we fund that system directly, whereas in England that scheme is funded by higher business rates on large businesses that then are used to fund business rates relief for small businesses; we don’t do that here in Wales. The fund is entirely the product of investment that is made by this Senedd. We will go on working with the sector, of course, but the future of the high street relies not on a simplistic belief that the problem is all in business rates; it is by looking at ways in which other high streets have managed to survive and thrive, and that is by diversifying the offer that they make, relying not simply on retail, but on leisure, on accommodation, on food as well. There is a successful formula for high streets here in Wales, and simplistic solutions won’t bring it about.

Luke Fletcher AS: In South Wales West, an important part of Bridgend town's local economy is Bridgend indoor market. Now, I'm sure the First Minister's aware that the market has closed due to reinforced autoclaved aerated concrete, and it was right to take action. What's important now is that traders are supported, especially given that this has happened just before the Christmas period. Therefore, could the First Minister outline what discussions have happened with Bridgend County Borough Council to support the market and to find an alternative temporary location so that market traders can trade?

Mark Drakeford AC: Llywydd, I don't have the details to hand of the discussions that have taken place, but I'm very happy that we can provide those to the Member.

Mike Hedges AC: I raised the success of the SA1 development in Swansea with the First Minister at a recent First Minister's questions, highlighting the success of companies such as Cyden and Veeqo, which the First Minister and I recently visited. I would also like to congratulate the Welsh Government on bringing £45 million into the former Toyoda Gosei plant, which will more than double Wales's plastic reprocessing capacity, and bring over 100 well-paid skilled jobs into Swansea. Can the First Minister provide an update on progress on developing the former Felindre tinplate site, which is the next large site available for development?

Mark Drakeford AC: I thank Mike Hedges very much for that question. What he has said, Llywydd, is an illustration of the point that I made to Tom Giffard, that there are successful examples where retail and high-street developments can be made to thrive, and the SA1 development, as Mike Hedges reported last week, is certainly an example of that.
Can I thank him particularly for pointing to what has happened in the company that will now help us to make a real inroad into the reprocessing of plastics here in Wales? It’s part of our overall scheme to make sure that we have reprocessing capacity. Once fully operational, it will help us to reduce the carbon footprint of Wales by around 150,000 tonnes every year, and that’s the equivalent, Llywydd, of taking 120,000 cars off the roads altogether, and it will deliver those 100 new and high-paid jobs for people who live in the wider Swansea area.
Parc Felindre, as Mike Hedges knows, is a strategic business park site created with Swansea Council in a joint venture. The good news is that there are encouraging signs this year, particularly, of new enquiries being received to acquire development plots at the business park and the Welsh Government continues to work with our partners to make sure that the most can be made of that very important and strategic site.

Electricity Standing Charges in North Wales

Jack Sargeant AC: 5. What discussions has the First Minister had with the UK Government about electricity standing charges in North Wales? OQ60085

Mark Drakeford AC: I thank Jack Sargeant, Llywydd. It is simply not right that an average household in north Wales pays £82 each year more in standing charges than an equivalent household in London. The regressive postcode lottery of standing charges needs to end, and the Minister for Social Justice will press that case again in her next meeting with the latest UK Minister.

Jack Sargeant AC: I agree with the First Minister’s comments and also thank the First Minister for his leadership and the leadership of the Minister for Social Justice on this issue. First Minister, it’s because of the failure of the UK Conservative Government that people in my community pay more, the highest standing charges for electricity in the UK; as you rightly pointed out, £82 a year more than residents in London. Let’s add this to the fact—[Interruption.] I can hear the chuntering from the Conservative benches, Llywydd, but let’s add this to the fact that, without the energy bill support scheme in place, households will be facing bills 13 per cent higher than last year. The Tory Government in Westminster are driving people in north Wales into poverty and into debt. First Minister, it's now more important than ever to ensure people facing energy debt get the best advice available to them to avoid them being forced onto prepayment meters, like we saw in the scandal of last year. First Minister, will you commit to doing all you can to ensure that this advice is available to residents in Flintshire and across Wales?

Mark Drakeford AC: Llywydd, let me congratulate Jack Sargeant for the persistence and the determination that he has shown in making sure that these issues are regularly brought in front of the Senedd, and that the pernicious impact of the way in which charges are levied in the energy market are debated here.
Llywydd, I don't make much of a habit of quoting reports produced in the UK Parliament, because we have our own ways of securing those insights for ourselves, but I did see the House of Commons Energy Security and Net Zero Committee report on this matter, because it was published only a few weeks ago. It is a committee that has a majority of Conservative MPs amongst its membership. They deal directly with both of the points that the Member has raised here this afternoon. They say in their report that the current standing charge structure is
'unfair and regressive and penalises those on lower incomes or who are actively reducing their energy usage',
and go on to make a series of practical proposals to the UK Government as to how that could be renegotiated with Ofgem as the regulator particularly. It also deals with a point that Jack Sargeant has made about advice, and I give him an assurance that the Welsh Government's investment in advice services continues, of course. But what the select committee said was that energy companies themselves should be required to provide advice, and to invest in those advice services so that intermediaries, charities and consumer organisations, as it says in the report, are able to access support for their clients over the winter months. And it said, Llywydd, that that should be in place ahead of this winter. Well, I think that's an important point, because, while we as a Government fill the gaps in advice services created by others, here is a profit-intensive industry that itself ought to be obliged to do more to make sure that those who fall into the difficulties that Jack Sargeant outlined at least have access to advice and help where they are available. The UK Government, as we would here, have a period of time in which they have to respond to the recommendations of the select committee's report. I think we should look forward to seeing that reply, and particularly some of those very practical suggestions, endorsed, as they were, by very senior Conservative Members of Parliament who sat on that committee.

Mark Isherwood AC: Although we welcome the commitment by the UK Government to freeze the level of the energy price guarantee from 1 April this year, Ofgem's announcement that the maximum amount energy suppliers can charge for each unit of energy would go down again from this month, including a reduction in the cost for people using a prepayment meter, and that the difference between price cap levels for a prepayment meter and for direct debit will be covered by the UK Government through the energy price guarantee until the end of March next year, energy standing charges are now at record highs and there is a huge regional divide, with north Wales and Mersey continuing to have the highest average costs in Great Britain—more than £380 a year—even before using a single unit of energy, compared to the lowest in London, at £299. What discussions have you therefore had with the energy regulator, Ofgem, given the statement in the March report on standing charges, produced by Ideal Economics and commissioned by National Energy Action, that, quote, multiple decisions taken by the energy regulator Ofgem have led to standing charges soaring?

Mark Drakeford AC: Well, I thank the Member for reinforcing the points made by Jack Sargeant and welcome his support for the actions the Welsh Government is taking in our discussions with the UK Government and with the regulator. I can assure the Member that I have met the regulator myself, that the Minister meets with them regularly. We have reported on the floor of the Senedd that we were not satisfied with Ofgem's original response to the crisis facing prepayment meter customers; we're glad that they have now made their code mandatory, rather than advisory, but there is certainly more that the regulator can and should do in the area of standing charges, as well as the treatment of prepayment meter customers more generally, and the Minister, as I said, will be meeting the Minister as soon as the Minister is available in order to reinforce that case.

Mental Health Services in the Betsi Cadwaladr University Health Board

Janet Finch-Saunders AC: 6. Will the First Minister outline any specific improvements to mental health services in the Betsi Cadwaladr University Health Board over the past 12 months? OQ60053

Mark Drakeford AC: Certainly, Llywydd. Over the past 12 months, specific improvements delivered by the board include improved performance against national targets for mental health services, extended services provided by the CALLhelpline, and the pan north Wales roll-out of the '111 press 2' telephone service, to provide support to people with urgent mental health needs, all day, every day.

Janet Finch-Saunders AC: Thank you. Now, today, of course, is World Mental Health Day, and it certainly reminds me of the increase in people that come now, reaching out for mental health support in Aberconwy. Lack of access to mental health services often leads those suffering to turn to drugs, alcohol or both to alleviate their symptoms. Now, prior to COVID, we had our concerns in Aberconwy. However, since COVID, I have seen larger numbers now wanting to seek support. Now, prior to devolution, there were between 18 and 21 detoxification and rehabilitation beds in Hafan Wen. There are now 25 beds. However, the majority of those are being used, and those beds are being purchased, for residents from north England. Hafan Wen provides a range of excellent drug and alcohol detoxification programmes to both NHS and private patients, but I'm so concerned that demand is outstripping the available support. So, bearing in mind that drug misuse deaths in Wales reached record highs last year, with figures nearly doubling, what steps will you take to ensure that north Wales residents, and indeed my constituents in Aberconwy, have access to detoxification and rehabilitation beds, especially when they come forward seeking this help and support? Thank you.

Mark Drakeford AC: Well, let me agree with the Member, Llywydd, that the call for mental health services certainly has risen in the post-pandemic period, and that it is very important for people who are suffering from mental health issues to be able to get the support they need quickly. I'm sure that Janet Finch-Saunders will have welcomed the fact that the '111 press 2' service is now available to all her constituents. It's available 24 hours a day, every day of the week; it received 5,000 calls in north Wales between March and September, and user satisfaction amongst people using the service was very high indeed. So, it's only a front line for people who need more specialist services; of course, you need things beyond that—[Interruption.] I'm answering your question about improvements to mental health services, and the points you raise yourself about the need for people to be able to access those services.
As far as Hafan Wen is concerned, and detoxification beds, the important thing is that these decisions are made by clinicians and practitioners in that field. Sometimes, they will refer people from the Member's constituency and north Wales to specialist services on the other side of the border, and sometimes there will be people who reside in England for whom Hafan Wen will be the best available service. I don't think that it would be sensible to restrict the Member's constituents to using services just because they are in Wales; we want those people to have the best service, and when you're dealing with people who have very specialist needs, and sometimes very complex mental health histories, often that will be in a Welsh service, sometimes it will be elsewhere, and I think that that means that those people get the right service, and the service that they need.

Support for Degree Apprenticeships

Hefin David AC: 7. Will the First Minister provide an update on Welsh Government support for degree apprenticeships? OQ60055

Mark Drakeford AC: I thank the Member for that, Llywydd. We are investing in degree apprenticeships to help employers boost productivity and economic growth. The number of first-year degree apprenticeships moved above 300 in the academic year 2021-22, for the first time. Next year, we plan to launch degree apprenticeships in the construction sector.

Hefin David AC: That's very helpful. Thank you, First Minister. I think the Government are doing a very good job at building and supporting degree apprenticeships. On 26 September, I attended the launch of the new rail degree apprenticeship, at Coleg y Cymoedd, Nantgarw campus. The apprenticeship is developed in collaboration between the college, the University of South Wales, Transport for Wales, and of course the Welsh Government. I think we need a longer, deeper conversation about how degree apprenticeships are funded in the future. I called for this specific degree apprenticeship in my report to the Welsh Government, and, also, I've called for that conversation—I think that is probably down the track. But this framework provides an opportunity to boost higher level skills in key sectors in Wales, particularly home-grown talent, to deal with the growing remit of Transport for Wales.
So, how will the Welsh Government decide in future which further sectors will get that support? How will employers be encouraged to work with education providers and the Government to develop further apprenticeships? And further, how will the new Commission for Tertiary Education and Research ensure that schools are encouraging those people who wish to go down those apprenticeship routes to take those routes?

Mark Drakeford AC: Llywydd, I thank the Member for those further questions, and for what he said about the development at Nantgarw, which I've had the chance to see myself in earlier stages of its development. It's a very impressive set of facilities that they have, and it will be making a real contribution to the future needs of that sector, in the way that Hefin David set out in his own report for the Welsh Government, by encouraging that home-grown talent, people who otherwise might not have thought of themselves as either being part of the workforce of that industry or indeed going to higher education, to be able to combine the advantages of being in the workplace and studying at the same time.
In relation to the Member's point about where next, well, the construction sector will be our focus in the coming months. That's the result of a lot of discussion with employers, to prioritise where we make the next move in expanding the range of our degree apprenticeships. We look forward to the continued involvement of those employers—they are vital to the success of the scheme, as Hefin David has said. And I think that the track record in Wales to date of our growth in the proper use of degree apprenticeships demonstrates that the recipe is working here in Wales.

Finally, question 8, Huw Irranca-Davies.

The Environmental Audit Committee Letter

Huw Irranca-Davies AC: 8. What consideration has the First Minister given to the implications for Wales of the letter from the Environmental Audit Committee to the Prime Minister on 2 October 2023? OQ60035

Mark Drakeford AC: Llywydd, the Environmental Audit Committee echoed many of the concerns expressed in our letters to the UK Government in relation to the Prime Minister’s watering down of key net-zero policies. We need to see the analysis underpinning those changes in order to enable us to evaluate the impacts on Wales.

Huw Irranca-Davies AC: I thank you for that answer. I'm a great fan of the work of committees, because they have a real role in holding the Executive—all Executives, all Governments—to account. But in the six-page letter of this Conservative-chaired committee—17-strong, by the way, just in case you're talking about Senedd reform, and so on; 17-strong committee—they really went to task on the Government. They went to task on the timing of announcements on backsliding on decarbonisation commitments—timing that suited the Conservative Party conference, but didn't suit the UK Parliament. But they went to town on the issues of backsliding on decarbonisation of transport, decarbonisation of energy efficiency and home building, decarbonisation of issues around electric vehicles and the move to battery production of vehicles, and more. They also, by the way, raised the issue of whether we could see the details on issues such as legislation on meat taxes, legislation on forcing people into private passenger vehicles by regulating the numbers of passengers, and so on. Would he agree with me that what we need is alignment across the UK on levels of high ambition on decarbonisation? And does he agree with me that, actually, what we need is a future UK Government that shares the level of ambition to reach net zero on the timescale we need of this Welsh Government?

Mark Drakeford AC: Well, Llywydd, I agree with all the points that the Member has made. There's no sense of irony in the Conservative Party, we understand that. A Prime Minister goes to his conference claiming to be making long-term decisions, and then makes a series of announcements on what surely ought to be the single-most important long-term challenge that faces us as a globe and backslides on almost every one of them. Llywydd, you don't need me to be someone to provide a verdict on what the Prime Minister has done; here is Tory MP Chris Skidmore, asked by a Conservative Prime Minister to chair a previous net-zero review. He said that this was the greatest mistake that the Prime Minister could possibly make. The former Conference of the Parties 26 president, Alok Sharma, the man who oversaw the Glasgow conference, said that abandoning climate plans would not help the economy, would not help his party at the ballot box, and led him to decide not to stand for the Conservative Party at the next election, while Lord Goldsmith accused the United Kingdom of turning its back on future generations.
Those are the verdicts of a series of people inside the Conservative Party—the people, in fact, with the best credentials on these matters, and they didn't stand back, did they, from exposing the realities of what lay behind the Prime Minister's decisions. Of course we need a different Government at the United Kingdom level that shares the ambitions we have in this Chamber to make sure that we genuinely face together that greatest challenge that will be there for future generations if we are not prepared to play our part now while that responsibility is in our own hands. And I'm afraid the evidence is absolutely clear: that will not be the Government we have today.

Thank you, First Minister.

2. Business Statement and Announcement

The next item will be the business statement and announcement, and I call on the Trefnydd to make the statement. Lesley Griffiths.

Lesley Griffiths AC: Diolch, Llywydd. There is one change to this week's business: Business Committee has agreed to reorder tomorrow's minority party debates. Draft business for the next three weeks is set out in the business statement and announcement, which can be found amongst the meeting papers available to Members electronically.

Darren Millar AC: Trefnydd, can I call for an update from the Minister for Health and Social Services in relation to NHS dentistry in Wales? I know we've had reason to visit this many times in the past, however, there are concerns in my constituency because yet another NHS dentistry contract is being handed back, in the Rhyl area, which affects the constituents of Clwyd West. That will mean that thousands more people are no longer registered with an NHS dentist. That's on top of the practice in Rhuthin, Rhuthin Dental Practice, handing back its contract earlier in the year; the White Gables Dental Practice in Colwyn Bay handing back its contract in June; and the Total Orthodontics contract service in Colwyn Bay also being axed. It sounds to me as though there are serious problems with the NHS contract reform that the Government has embarked upon, and this is forcing more and more dentists out of NHS dentistry. We need an urgent statement because this is becoming a very serious and acute problem indeed, and if we're not careful, no-one will be able to access an NHS dentist in north Wales or elsewhere.

Lesley Griffiths AC: Thank you. Well, as you referred to yourself, the Minister for Health and Social Services does keep us updated frequently with regard to dentistry provision right across Wales. As you're aware, we've worked very hard with dentists right across Wales in relation to the new dental contract, and there are 26 out of 400—that's all—that have not taken part in the new contract, which is a very small 4 per cent.

Heledd Fychan AS: Trefnydd, I'd like to request two statements, please. First of all, I was really grateful that we had the Minister for Economy last week give a statement on UK Windows & Doors Group, but obviously, as the situation progresses, I wonder if we could receive an update next week. Workers will be fearful, obviously, because from the twenty-fifth of this month, they won't know the situation in terms of what happens next. I know support is in place, so I would be grateful.
The second is one I did request last week, but I would like to ask you to reconsider, from the Deputy Minister for Arts, Sport and Tourism. Again over the weekend, we saw, around Amgueddfa Cymru's collections, 2,000 items being missing from those collections, in addition to the ones that we saw from the National Library of Wales. The culture committee of the Senedd has been previously warned about risks to the collections, because of some funding issues. So, I think, given the national significance of our national collections, and the importance of Amgueddfa Cymru and the National Library of Wales, I think a statement would be appropriate, if possible.

Lesley Griffiths AC: Thank you. Well, I haven't changed my position from last week. I'm not downplaying what has come to light, and I'm sure the library is certainly looking into this very carefully. I don't think it's appropriate for an oral statement or a written statement at the current time.
In relation to your first question, as you say, the Minister for Economy did an oral statement last week around the position of UK Windows & Doors Group. Discussions are ongoing. Again, I don't think an oral statement next week would be worth while, because I know the council are holding a jobs fair next week.

Sarah Murphy AS: I just wanted to say 'thank you' to Welsh Government and our health Minister. I really welcome a statement on the Elvanse shortage, the ADHD medication—a really proactive response there from Welsh Government. But I would welcome another update as the situation is just progressing and developing and becoming, I fear, quite distressing for many of our constituents out there across Wales. More information is coming to light that suggests that, actually, the Elvanse situation won't be stable until the new year, and that patients might well have to go without medication, because they've been told to try to put them on to something else, but, obviously, now that's causing shortages. It is a manufacturing issue, it is a global issue, there has been an increase in demand. However, I do feel now that we're all going to be getting our constituents getting in touch with us, they're going to be very distressed. This will have huge implications for mental health, this will impact all ages, and I was just wondering if Welsh Government could give an update on how resources will be put in place, so that people can have those medical and medication reviews and be given support whilst they have this crisis. Diolch.

Lesley Griffiths AC: Thank you. Well, as you say, the Minister for Health and Social Services did give an update on the issue you raise. And we are aware the current supply disruption to ADHD medicines is temporary, and it is expected to be resolved, for some items, this month, and for all items by the end of the year. The Minister will shortly be issuing a written statement to Senedd Members about medicines shortage generally. But I think it's really important that we remind people, if they are experiencing difficulty in obtaining their medicines, they should discuss that with their clinician.

Samuel Kurtz AS: Can I call for a written statement from the Deputy Minister for Climate Change in relation to the reopening of the St Clears railway station, please? The UK Government have committed £5 million to this project, with Transport for Wales due to fund £1.6 million towards its reopening. We're now three years since the funding was announced and there's been no progress to date. In a recent written answer to me on this topic, the deputy climate change Minister mentions that the proposed new hospital in either St Clears or Whitland is being taken into consideration. As the reopening of the St Clears railway station wasn't conditional on the location of a proposed new hospital, there are genuine concerns locally that the decision on the hospital's future location is masking inactivity from the Welsh Government and Transport for Wales, who are not serious about reopening this much-needed station. So, could I please request a written statement, to provide clarity as to the current status of the reopening of the St Clears railway station, so certainty can be given to the community? Diolch.

The Deputy Presiding Officer (David Rees) took the Chair.

Lesley Griffiths AC: Thank you. Well, I wouldn't think there is anything further that the Deputy Minister for Climate Change could add to the written answer he's recently given you.

Rhun ap Iorwerth AC: May I ask for a statement from the Minister for Climate Change on the Welsh Government strategy to take advantage of Wales's potential in the area of hydrogen? Indeed, a joint statement by the Minister for Climate Change and the Minister for economic development would be very useful, because there is such an opportunity here to create jobs, as well as to respond to environmental challenges. I was very pleased to sponsor an event, which is still ongoing today, on the Senedd estate, looking at how we can unlock the potential of hydrogen in Wales. Representatives of businesses and governments from across the world were there. It's one of the largest events of its kind I've seen here in the Senedd, and it was good to have an opportunity to listen to those experts on how to develop what we have here and to tie the Welsh developments into the international picture on hydrogen. We have the natural resources, we have the ports, the infrastructure, the research, and so on. And we have support from the Welsh Government to the principle of developing hydrogen, but what we need is to move that forward so that it becomes something that is truly robust and a clear plan to take the sector forward.

Lesley Griffiths AC: Thank you. Yes, I think you make a very important point, and particularly for us in north Wales, this is a massive opportunity, I think, and the Minister for Climate Change will be happy to bring forward a written statement.

Jayne Bryant AC: Trefnydd, could I ask for a statement on support available to families who have lost a baby? As Members will know, this week marks the twenty-first year of Baby Loss Awareness Week, a week for everyone in the baby loss community and beyond to come together to remember and commemorate much loved and missed babies. A constituent has shared with me the devastating impact losing a child at nine weeks and four days has had on her. She told me that her baby loss was identified via a private scan, which means she had a picture to keep and to remember, but, for so many, the loss happens unexpectedly, so they have nothing tangible to help them remember. The impact of losing a baby cannot be underestimated, and the depth of feeling does not diminish over time.
Trefnydd, in Scotland, a baby loss memorial book for those who've experienced a pregnancy or baby loss prior to 24 weeks was launched over the summer, and those who've experienced a loss will be able to apply for a commemorative certificate, which will give recognition and comfort to those who want to record their loss. The service is free of charge and completely voluntary, and something like this can be vitally important as, among other things, it allows a baby's life to be commemorated by their loved ones, something many of them don't often have the opportunity to do. So, having this available could make a big difference to parents who have already been bereaved, and to those who sadly will lose babies in the future.

Lesley Griffiths AC: Thank you. I think the Member raises a very important point, and, as you say, this week does mark the twenty-first year of Baby Loss Awareness Week, and I sympathise deeply with parents who have lost a child. We know that many people who experience both pregnancy and baby loss may suffer from disenfranchised grief, where they feel that that bereavement has not been acknowledged or, worse, even supported. So, we want to ensure that bereaved parents are offered equal, high-quality, individualised, safe and sensitive care in any experience of pregnancy or baby loss.
The Deputy Minister has been working to design and implement the national bereavement care pathway for pregnancy and baby loss, working with Sands and a number of organisations and experts in this area, because we do recognise how important this work is. And we are committed to ensuring a certification process is delivered across Wales to formally recognise baby loss, with the Minister's officials working with their counterparts in the UK Government to be able to extend that process here in Wales. There are a great number of women and families who contributed to the UK Government's commissioned independent pregnancy loss review, and I'm sure we can allappreciate how distressing it was for them to have to recall their experiences. And it's really vital, however, that those stories are able to inform the services that we're able to offer. 
I do think we've made significant improvements to bereavement services, and we continue to work with stakeholders to design and implement the national bereavement care pathway for pregnancy and baby loss, as I referred to earlier.

Laura Anne Jones AC: Business Minister, may I also request a statement from the Deputy Minister for Climate Change? As you may know, your Government has decided to reduce the speed limit on a stretch of the A40 dual carriageway in Monmouthshire. A very dubious temporary 18-month order has been approved to lower the limit from 70 mph to 50 mph between the Raglan roundabout and Hardwickroundabout in Abergavenny. Lowering the speed limit to 50 mph is confusing when the national speed limit on single carriageways that do not have that central reservation to separate opposing flows of traffic is 60 mph. The whole reasoning behind it is not stacking up. Safety barriers don't disintegrate or suddenly lose their integrity. There are concerns that the Welsh Government could end up turning this temporary order into a permanent one and that 50 mph will be the new norm, not just on these roads but roads like it across my region and Wales. So, I'd like to request a statement from the Deputy Minister for Climate Change to confirm his long-term plans for this stretch of road, please.

Lesley Griffiths AC: Thank you. You started your question saying it was temporary and then swiftly moved to permanent. I don't think it's confusing as long as the signs are very, very clear. You will have heard the First Minister talk about the different variations of speed limits in Liverpool and right across the north-west of England. I myself drove to Liverpool to conference from my home, and I went through every speed limit imaginable, but so long as it's clearly signposted, there is no confusion. I know you're trying to make it, but there really is none.

Natasha Asghar AS: Minister, can I please request a statement from the health Minister updating the Welsh Parliament on the Government-supported Deep End project? St Paul's clinic in Newport has around about 6,000 patients, and apparently has a higher rate of diabetic patients than anywhere else in the country. I've also been told it is the second-most deprived surgery in Wales. Despite a huge workload, they are struggling to get any doctors to work there, with locums charging an arm and a leg. I'm sure you're probably thinking that's the case everywhere, but they do need to have a fully funded GP. There are talks about mergers, but the lead GP is not keen on this because she fears that the clinic will be shut down and doesn't know what will happen to the current patients. So, I'd really appreciate—and I know St Paul's clinic would also appreciate—a statement from the health Minister outlining exactly how the Deep End project will help surgeries like this one, going forward. Thank you.

Lesley Griffiths AC: Thank you. You do raise a very specific question. I do think it would be better if you wrote to the Minister for Health and Social Services, who's in her seat, and I think she would welcome that.

And finally, James Evans.

James Evans AS: Diolch, Deputy Presiding Officer. I'd like to ask for a statement from you in your capacity as rural affairs Minister on the Habitat Wales scheme. Last night I attended an NFU Cymru Brecon and Radnor branch meeting, and farmers there were very, very concerned about the Habitat Wales scheme, the way it has been administered and how it's going to roll out, going forward. There've been issues with the mapping, the 400-acre cap, and the misunderstanding of the whole-farm code and the restrictions that apply to that. There've been delays to webinars for farmers—and I respect that those are coming out today—the low payment rate, and also the non-payment on BW1 land on stock-excluded woodland. I had some farmers ask me there if that now means that they can rip the fences out and put stock back in those woodlands again. So, I'd like an urgent statement on this matter so we can debate it and get it more openly explained to farmers what they need to do, because the good faith that has been built up over the years is being lost on environmental schemes. We don't want to be seen to be going backwards here, and that good faith between the Government here and farmers needs to be rebuilt, and I think a statement from the Government on the scheme would go some way towards restoring that faith in what you're trying to do here.

Lesley Griffiths AC: I've already done a written statement on the habitat scheme, which opened, as you know, for expressions of interest on 29 September. We've already had 235 applications. There was an issue that my officials have worked really quickly to rectify. I'm not sure if the Member knows, but an update was sent out to all stakeholders yesterday. I'll be very happy to send you that update if you haven't had sight of it. That note did confirm the steps that were taken to resolve the initial issues that were identified.

I thank the Trefnydd.

3. Statement by the Minister for Climate Change: Ending homelessness in Wales

Item 3 is next, which is a statement from the Minister for Climate Change on ending homelessness in Wales. I call on the Minister for Climate Change to make her statement—Julie James.

Julie James AC: Diolch, Dirprwy Lywydd. Today, on World Homeless Day, I am publishing our White Paper on ending homelessness in Wales. In doing so, we are delivering on our programme for government and our co-operation agreement commitment to fundamentally reform homelessness services to focus on prevention and rapid rehousing. The White Paper marks a monumental shift in our response to homelessness and, in the words of one of our stakeholders, is world leading in its aims.
It is crucial we make the transformational shift set out in the White Paper and that we have these enormously ambitious aims. The landscape in which homelessness services are working has irreversibly changed in recent years. The impacts of the pandemic, the cost-of-living crisis and humanitarian crisis arising from the war in Ukraine have all placed significant pressure on the Welsh housing system. But, in the face of this pressure, we have achieved exceptional things. Since the start of the pandemic, we have assisted almost 40,000 people experiencing homelessness with temporary accommodation. Much of this homelessness was hidden—some people were living on the streets, some were sofa surfing, and many were not accessing any of the support they needed. Through exceptional partnership working with our local authorities, we have lifted the lid on homelessness in Wales and begun to address its true scale. As I have said before, there is no going back. Homelessness has no place in a civilised society.
We must now turn to sustaining this change and to achieving our long-term goal of ending homelessness. The White Paper sets out the framework through which we will achieve this. Dirprwy Lywydd, it is a long-term vision, and one that requires radical, systemic and cultural change. It will not be easy to achieve but it is a change that must happen, and we must begin the process now.
The White Paper is based on the work of an expert review panel chaired by Professor Suzanne Fitzpatrick and made up of expert stakeholders working across Wales to end homelessness. I want to take this opportunity to express my heartfelt gratitude to them for their considered and comprehensive report, and for their collaborative work with us over the past year. Crucial to the work of the expert panel, and the White Paper, has been the essential contribution of over 350 people with lived experience of homelessness who have informed this work and played a pivotal role in conveying what it really means to be homeless. Dirprwy Lywydd, can I also pay tribute to my own incredible team of officials, who have also been wholly committed in delivering this work?
Homelessness can be a traumatic experience. It can rob you of your dignity, your health and your self-worth. I want to thank and commend every person who shared their experience with us to develop this White Paper. I had the pleasure of meeting them, alongside Siân Gwenllian, this morning, and hearing their some of their experiences was a salient and sobering reminder of the impact of homelessness, and the importance of our shared ambition to end it. So, Dirprwy Lywydd, today I present a White Paper rooted in both evidence and experience—a White Paper that seeks to address the challenges of today and set in motion radical reform for the future.
I’m sure many of my colleagues in the Chamber today have, in their constituency roles, responded to people who are struggling with homelessness. I’m sure some of them have been in crisis, experiencing homelessness that could have been prevented. Our proposals will mean that public services will work together to identify and prevent homelessness before it happens and to work with people to ensure lasting positive outcomes.
Some of you may have been asked to help people refused a homelessness service because they aren’t deemed to be in priority need or have been found to have made themselves intentionally homeless. Our proposals mean that such tests will be abolished. You may have tried to help people with multiple support needs traverse a complicated system to get the help they need. Our proposals target those most at risk and require a range of public bodies to co-operate to help keep people in their homes.
Ending homelessness is not just about providing a roof over a person’s head; it is about addressing the wide range of causes and consequences of homelessness and finding the right accommodation in the right place at the right time. Through these reforms, we will work with our partners to ensure that the standards of accommodation are raised, that we maximise the use of social housing and that we expand the range of housing options on offer to people experiencing homelessness. As we do so, we will continue to focus our efforts on increasing and diversifying housing supply and building cohesive communities across Wales.
The proposals in this White Paper will help to sustain our achievements to date and provide some of the long-term solutions to the problems we face today. Dirprwy Lywydd, this is not a quick fix but an evidence-based, expert-informed package of reforms that transforms the homelessness system and creates a system fit for the future. Ending homelessness in Wales means ending the wider disadvantage, trauma and disruption that homelessness can cause. Our proposals will bring individual benefits to every person at risk, but, over the longer term, they will also benefit our ever-in-demand public services. Dirprwy Lywydd, I am pleased and honoured to share the White Paper with the Senedd today and to continue the radical and bold action we must take to end homelessness in Wales. Diolch.

Janet Finch-Saunders AC: Thank you, Minister, for bringing this forward, but, I'm sorry, on this one, I cannot pull any punches, because, frankly, to launch this paper on homeless day in itself is rather baffling, when only recently you were on tv—I think it was last week—where you denied the fact that it's your policies on homelessness, the Renting Homes (Wales) Act and things like that that are actually increasing homelessness. Dirprwy Lywydd, I will declare an interest in terms of property ownership.
Now, for three decades nearly, you in Welsh Labour have been responsible for housing—yes, for building houses so that our constituents have homes to live in. Look what you have achieved: 10,931 individuals now living in temporary accommodation. That is the highest level since the Welsh Government began its current monitoring programme. It is a disgrace. Three thousand, three hundred and fifty dependent children under the age of 16 are living in temporary accommodation, a third of whom are in hotels or bed and breakfasts. That is a disgrace. Rough-sleeping has increased by 69 per cent since July 2021. That is a disgrace. Housing support grant—the funding is due to remain the same as last year, with £166.7 million allocated. That's a real-terms cut of 8 per cent.
Now, referring to the Renting Homes (Wales) Act 2016—. I will say, to be fair, Julie, the Minister, hasn't been in post all those years, but has been in post and responsible for this portfolio for quite some time now. So, it's really frustrating for us when we've come to you with good suggestions about how you can improve and increase housing stock and we've just been completely ignored. Referring to the Renting Homes (Wales) Act 2016, Dr Lindsay Cordery-Bruce, chief executive of The Wallich, said:
'We have seen landlords leaving the sector'—
she means private landlords—
'We have heard anecdotal evidence about it for a few months, but it’s more recently been confirmed that this is becoming a cause of homelessness, that landlords aren’t able to meet the standards stipulated in the Renting Homes Act so they’ve had to sell up and leave the sector.'
For every anecdote that she's heard, I've received numerous more. Your Renting Homes (Wales) Act 2016, with all the regulations, all the added bureaucracy, is just driving landlords out of the sector—[Interruption.] Do you want to make an intervention?

No. There are no interventions during a statement.

Janet Finch-Saunders AC: Well, could you just ask him to let me deliver my—?

Yes, just continue.

Janet Finch-Saunders AC: Despite our repeated warnings that the Act is causing landlords to leave the sector, you have not listened. You're not listening to Dr Bruce, chief executive of Wales's leading homelessness charity. Your response to her that you have no actual empirical evidence shows that you are burying your head in the sand. You and I know, Minister, that the temporary accommodation spend is going up and up and up, not yearly but weekly and monthly, in our local authorities. So, people are moving out of properties and into these hotel rooms.
The question I have for you is this: reforming housing law is a key part of the programme for government 2021-26, so will you now listen to the PRS and implement changes to the Act so that it is less likely to cause landlords to leave the sector? That puts a burden on these families and even my own local authority's housing team to find accommodation. We just haven't got it. Deregistration numbers are climbing—13,061 deactivations have been recorded between 2018 and 2021, an average of over 4,000 per year. In 2021-22, that number climbed to 7,629. We've done so much work on this as a very small office ourselves, so, for you, with a team, a department—. I just don't know why, when we've actually sent you figures and you can see the homelessness spend going up, you don't actually equate it to the fact that there's less stock on the market for people to move into.
My proposal would be for positive co-operation between Government and landlords, and also cross-party in this group, rather than villainising them. If you don't achieve that, the abolition of priority need will be a catastrophe for local authorities; even more will be living in B&Bs and hotels. The White Paper today itself is your own admittance that the Welsh Labour legislation, the Housing (Wales) Act 2014, has not been successful. And we all know that in 2022, this last Christmas, people had to have converted tenancies—again, there are people out there renting out properties who don't actually know what they're being asked to do.

Janet, you need to conclude now, please.

Janet Finch-Saunders AC: I will. Minister, it is time that you started working with us and working with—. Well, you're already working with Plaid Cymru. Homelessness in Wales is a by-product of this Welsh Labour Government, and, frankly, it's disgraceful.

Julie James AC: Well, where to start? First of all, this paper is not about the Renting Homes (Wales) Act 2016, it's about the general homelessness situation we find ourselves in. We do have very large numbers in temporary accommodation, Janet. Those people would be on the street if they lived in England—let's be clear. If you want to keep priority need, that is a way of keeping people out of accommodation and on the street. If you don't understand that fundamental, I just don't know where to start with you. The idea that the solution to this is to allow landlords to rent homes that are not fit for human habitation in order to stop you having to look at somebody on the street is for the birds. Honestly, can I suggest that you actually read the advice of the homelessness advisory panel, and of the expert group? And can I suggest that you, for once, listen to the lived experiences of the people in the system? Because what they're saying and what you've just said are literally poles apart.

Mabon ap Gwynfor AS: The only solutions we get from the other side are to transfer more public funds into private pockets, to transfer more of the money of the poor to private enterprise and to develop that sector rather than addressing the real problem facing us. I want to take this opportunity to praise the Welsh Government in this case for taking this significant step forward to tackle homelessness. It is encouraging to see this Government committing to finding a solutionto a problem that is complex and a national problem for us. I'm very pleased that Plaid Cymru too has playedits part in this process.

Mabon ap Gwynfor AS: Ensuring that every individual has the right to a safe and secure place to call a home is not just a moral imperative, but a fundamental human right. I believe that change has to be driven by the introduction of the right to adequate housing in Welsh law. By enshrining this right in law, we could send a clear message that homelessness is unacceptable in Wales and we hold ourselves accountable to it.
However, as we all know, prevention is often the best cure. We must upstream our efforts to identify and support individuals and families at risk of homelessness before it happens. Homelessness prevention should not be an afterthought, but a central component of our strategy. I remember talking to people in the homelessness prevention sector in Finland, who explained how they were tackling homelessness and upstreaming to a far greater degree than we see elsewhere. So, I'd like to ask the Minister: how does this legislation plan to strengthen upstreaming efforts? Are there concrete measures in place to spot those at risk and provide them with the necessary support?
Cross-sector collaboration is another crucial aspect of effective homelessness prevention. Homelessness is not a problem that any one agency or organisation can solve on its own. We must work together across sectors, including health, education and social services, to identify those in need and provide comprehensive support. So, can the Minister shed light on how this legislation promotes and facilitates cross-sector collaboration to prevent homelessness? Within that, of course, we know that local authorities provide a large part of the services to tackle homelessness, and we need to see an increase in the level of housing support grant. So, what action is the Government taking to see this specific grant increased over the coming number of years?
While prevention is paramount, we must also address the immediate need for housing. It's not enough to simply prevent homelessness, we must also provide affordable and accessible housing options for those in need. Social housing plays a vital role in this regard, but it's equally important to ensure that social housing is available in the right locations where essential services, transport links and employment opportunities are easily accessible. So, I'd like to ask the Minister: how does this legislation address the issue of housing availability and location? Are there plans in place to invest in social housing development that is strategically located to offer residents the bestchance of success and stability?
In conclusion, I'd like to reiterate my support for the Welsh Government's efforts to address homelessness through this legislation. As this is part of our co-operation agreement, this legislation would not be possible without Plaid Cymru, and I look forward to working with the Minister to ensure the legislation works to remedy the crisis we're enduring. The right to adequate housing, upstreaming work, cross-sector collaboration and strategic social housing development are all crucial components of a comprehensive approach to ending homelessness in Wales. However, as we debate this legislation, let's remain vigilant and ensure that the proposed measures are robust and effective. We must not only focus on addressing the symptoms, but also work diligently to eradicate the root cause of homelessness. Last week, I shared Polly's story, and I understand that this legislation will take time to implement and bed in, but I sincerely hope that it will lead to giving Pollyand others like her a chance at life. Diolch.

Julie James AC: Diolch, Mabon. I really couldn't agree more with everything you've just said. This is about understanding that people who become homeless could be anyone, could be you or I. Most people are only three or four rent payments away from homelessness. If you listen to any of the stories, it happens to all classes, all people, all walks of life. It's true, though, that if you suffer childhood trauma, that if you've had a chaotic upbringing, you're more likely to experience homelessness, so it adds injustice to injustice, doesn't it?
Amongst the many things we've got to do, you're absolutely right, is to upstream this. So, together with Jeremy Miles, the Minister for education, we've increased, for example, the funding to the youth engagement and prevention teams across our education establishments looking to find children who look as if they might be experiencing the kind of childhood experiences that we know might lead to homelessness, and to pick them up with their families, or with whoever their guardians are, and try and address it early stage, early doors—the quicker the better, the faster the support services are put in place. And then, for those who have fallen out of housing and have become homeless, whether they’ve actually made it onto the street or whether they’re actually sofa surfing or have a very insecure set of housing, the thing there is to wrap the support services around them as fast as possible.
Siân Gwenllian and I met a couple of people this morning—three people, actually—who’ve contributed directly to this piece of work, and hearing their stories—. I mean, it’s just absolutely extraordinary what human beings can overcome, given the right kind of support services. They could not have emphasised more clearly how much they rely on the support of the support workers around them, and it was clear how dedicated those people were. And so what this is about is making sure that all public services play their part in wrapping that support around people. In the example of one of the people we spoke to this morning, somebody who had had a major operation and then was released with no particular place to go, and ended up immediately on the streets after a big operation, the result of that, of course, was they were readmitted for very expensive medical care not very long afterwards and had a much more traumatic experience. So, you can see the saving involved in actually just addressing the housing needs in the first place.
It is about making sure that there is a duty not to release anyone from any kind of public service into homelessness. It isn’t enough to just say, ‘Oh, go to housing options; they’ll pick you up’. It is about every single agency working together to make sure that that person is picked up and supported. But much more importantly, it’s about making sure the advice agencies are in place. A lot of this crisis is being driven by the cost-of-living crisis that the benches opposite like to deny has any implication for it. But it’s quite clear that families under huge financial pressure suffer family breakdown in all kinds of circumstances, so it's about getting the right advice in there early on, making sure that we understand what could happen to keep that family together and in their home, or if they are going to separate, to make sure that they do so in as less traumatic a way as possible, and that both parties involved in that family maintain their housing. That would be absolutely transformational in and of itself. The suggestions in the White Paper are how can we do that, what role can the public sector have across the board in it, how can we pick people up before they fall through the cracks, how can seal the cracks up so that they’re not there, and then ultimately—and it’s a long-term goal—to make sure that it becomes rare, brief, and never repeated.

Mike Hedges AC: I very much welcome the statement by the Minister. Homelessness is an affront to any civilised society. I welcome the actions of the Government and the acceptance that homelessness is not just rough-sleeping; it is people sofa surfing, sleeping on floors, who have no fixed abode, or living in massively overcrowded accommodation. We need more social housing, including council housing. We need to build council housing back at the level we were building in 1950s and 1960s, but we also need to support the private rented sector. A large number of those who are homeless need supported accommodation to stop them becoming homeless again very quickly. Just giving them a house will not solve the problems of a very large number of the people, including a number living in supported accommodation within your own constituency, Minister. The Minister and I visited Hafod school last week to discuss homelessness with the children there, and we both visited the excellent Matt’s Cafe in the Minister’s own constituency. I just want to know whether the Minister shares my concern about the number of houses and flats becoming Airbnb and being removed from being available to rent.

Julie James AC: Diolch, Mike. It was lovely to meet the children and to hear their concerns about homelessness. The school is in my constituency, but its gates open into Mike’s constituency, so it’s very much a shared school for us. And it was lovely to see their campaign: they’ve marched through the city centre, they’ve raised awareness, they've raised an enormous amount of money that inspired their headteacher to do the 10k; he seemed quite surprised himself that he ran it successfully and raised quite a lot of money. They’ve run round and round the yard for 10k with him to do the training, they’ve raised an enormous amount of money, and in a community that isn’t well blessed with funds, actually, so they’ve really worked hard to do it. And they’ve done it because they themselves could see, from the smallest nursery child to the year 6 leavers, the sheer injustice of what happens to you when you lose your home. They were absolutely inspirational, and Matt’s Cafe in my own constituency does the most incredible work in making sure that people remainwith some kind of dignity and self-possession if they do find themselves homeless.
We've had a huge amount of engagement with people through Cymorth Cymru and through Tai Pawb, listening to their lived experience, listening to what they say would help. Mike's right—access to housing is one of the fundamentals. But there's no point in putting somebody in a house miles from their community, miles from their support, miles from their work, miles from their network of friends. None of us would be able to sustain such a house, and neither should anybody else be asked to. So, this is absolutely about making sure that the right referral to the right kind of accommodation, for the right sort of people, with the right support, including wider family support, is there and is looked at holistically. We really need to do that. We need to make sure that all our services are doing this together, and I truly, truly know—I know, because you can see it in other countries—that if you can get the system running properly, it lightens the load on all of those services, because people just don't call on them so much if they're able to stay in their own home.
But what we fundamentally need as well is a system of benefits that allows people to stay in their home. So, the iniquities of the bedroom tax, for example—it's important to not forget that that still exists. The appalling state of the local housing allowance and the freezing of it years ago means that people on benefits—and most people on benefits are working, just let me remind everyone—those people who rely on those benefits, are really struggling and are paying, in some cases, 50 or 60 per cent of their income on their housing costs. I mean, that is absolutely appalling, and that's really the issue that Janet Finch-Saunders and her benches should really be thinking about.

Rhys ab Owen AS: In 2004 I was at a meeting of the homeless tea that the members of the Welsh-medium churches in Cardiff had been providing on a weekly basis since the 1970s. We discussed at length about bringing the tea to an end, because the number of attendees had fallen to under a handful. But then came austerity, and we cannot forget the terrible consequences of that ideology, which will be felt for generations. However, the provision did come to an end during COVID, when accommodation was found for all of the homeless people in Cardiff. Yet, now, it seems we have more homeless people on the streets of Cardiff than every before. The homeless provision in the Tabernacle chapel in the city centre has increased from a weekly one session to three sessions a week, with as many as 60 attending to receive a hot meal, clothes and sleeping bags. I'm so glad that the White Paper has included the views of homeless people. Mabon ap Gwynfor mentioned Polly. It is so important to listen to the stories, to put a name to a face, and to hear what they've been through.
You are right, Minister, it can happen to anyone. Over the years, I've met a former pharmacist and a teacher on the streets of Cardiff. The demographics have changed a lot over the past few years. For decades, those attending the homeless tea tended to be older men with a drink problem. Now, they are much younger, with many young women attending—

Rhys, you need to ask your question, please.

Rhys ab Owen AS: —who have been let down by society. How will the Minister stop these vulnerable individuals becoming homeless? Diolch yn fawr.

Julie James AC: Diolch, Rhys. So, the engagement—. I can't emphasise enough that the engagement carried out by Cymorth Cymru—. Three hundred people who had experienced homelessness contributed to this—directly contributed to the expert panel and then to the White Paper. Tai Pawb carried out engagement with 50 people with lived experience and other protected characteristics: asylum seekers; refugees; disabled people; black, Asian, minority ethnic people; Gypsy, Roma and Traveller people; LGBTQ+ people; older people. So, we have the voices of a huge range of people who've experienced our own services, and, frankly, understand the journey from housing to non-housing, in this paper. I just want to emphasise that, because that is a really important part of what we're looking at here. Just speaking to people this morning, 'How did this happen to you? What happened afterwards? Why weren't you picked up?', and the multitude of lost opportunities to pick that person up and help them put their life back in order are the things that we are really focused on here.
So, this is not going to be an overnight thing. We are facing a cost-of-living crisis following a pandemic. We are facing an economic turmoil the like of which we'd never seen before. We are facing really serious housing costs right across the UK, which really do need to be addressed, and there are a number of other things we're doing in the co-operation agreement to address the whole issue around second homes and Airbnbs and so on, which will, we hope, increase the housing supply. But in the end this is a people crisis, and it requires the support services to come together to help people, prevent the homelessness in the first place, as I said in answer to Mabon, and then, if it is happening, to pick them up as swiftly as possible and wrap them with the support services they need. I am absolutely convinced that if we can get this right, in 10 years' time, we'll wonder why we just didn't do it like this in the first place. So, I think, together, we can really make this happen in Wales, and we can be the beacon of hope across the UK that we know we can be.

John Griffiths AC: Minister, as you've mentioned many a time, Llamau is one of the organisations in Wales that has a great deal of experience and knowledge to bring to the table, and recently they've been, as ever, looking at the current trends and situation of young people in Wales as far as homelessness is concerned, and they are alarmed that, unfortunately, youth homelessness is increasing at a very worrying rate, and they particularly call for the upstream approach that Mabon and others have referenced, that we get more into prevention and early identification. They point out that often youth homelessness is relatively hidden because of sofa surfing, and also that care leavers at transitional stages in their journey through life are particularly vulnerable, and too often they're housed in temporary accommodation that's unsupported and not sustainable in many ways. They're calling, Minister, as I'm sure you're aware, for increases in the housing support grant for strengthening those early identification, intervention and prevention services, for better support for care leavers at those key transitional stages, and also continued support for domestic abuse and gender-specific services. I'd just be grateful for you addressing those particular calls, Minister, if you would.

Julie James AC: Diolch, John. I'm very familiar with Llamau and all of its work, and very essential it is too, and its particular emphasis on youth homelessness is very much welcomed. We know that there are a whole range of causes for youth homelessness, but, again, family breakdown is very much a part of that, so getting upstream of that is really important. It's particularly important where homelessness is caused by a protected characteristic of one sort or another, or where the child has not been able to be supported properly in the home. So, as I just said, we've strengthened the youth progression and engagement framework—the other way around: the youth engagement and progression framework—alongside Jeremy, to make sure that the work going on in schools is upstreamed, and that we can pick people up as soon as there are any signs at all that there may be insecure housing associated with that particular individual child. The White Paper has proposals for specifics around looked-after children and children coming out of the youth justice system, to make sure that we pick up people who are already in the system.
Again, like I say, part of the issue here is the appalling way that the benefits system is constructed, because if you're young, the assumption is that you can just live at home and your parents will be rich enough to afford that, and you'll just be able to stay there, and we know that that is a stark contrast to the reality that many children or young people face. So, reforming the benefits system so that it's fair and delivers social justice, which is what it was actually intended to do, of course, rather than the punitive system that we have at the moment if you're under 35, is one of the essential things that we hope an incoming Labour Government will do at the UK level. In the meantime, we're putting a sticking plaster over some of that, there's no doubt, but we do want to provide good services for people who have specific needs, and they will have many different support needs, but the same adage is there, isn't it: find out what the person's support requirements are by good outreach, good engagement, and then pick that person up with the right support and put them into the right accommodation, in the right place, so that their extended network can also help them. So, it's the same formula, but perhaps delivered even more quickly for a young person because they're at the centre.
The only other thing I would say on that is that a lot of this is about making a person who is experiencing homelessness or insecure accommodation feel able to have some kind of future. So, the link with—my colleague Lynne Neagle and my colleague Julie Morgan and I have had several conversations about this—social services and mental health support services for young people is even more essential, isn't it, to make sure that that young person actually understands that they have the potential to be the best person they can be. So, I absolutely think Llamau does the most amazing work, and we'll continue to work with organisations like them, as we roll the system out. I'm sure we will get a fulsome response to the White Paper from them, John, and I'm sure you'll help them do that.

And finally, Sioned Williams.

Sioned Williams AS: Thank you, Dirprwy Lywydd. Thank you for the statement, Minister. It's disgraceful, isn't it, that such a thing as World Homeless Day exists, that income inequality between the wealthiest and the poorest is increasing, that 10 per cent of the richest people take 52 per cent of the income home, and that the UK has an extremely high level of income inequality, as compared to other developed nations. There is nothing that depicts the failure of society more than when some of its members don't have a roof over their heads, and as a result of that, don't have access to the support that can provide hope for a dignified, fair life.
I welcome the White Paper, which emanates from a decision taken by Plaid Cymru along with Government, through our agreement, to improve the way that that support is provided and to place that crucial focus on the prevention of homelessness. There is much to be done to deliver this transformational change, so I'd like to know, Minister, how the support and how the work will be funded, particularly given that the third sector and local government and other public bodies will be at the core of providing this support and are facing serious funding problems, and sustainability of funding is often an issue that is raised as something that does have an impact on the ability of organisations to retain staff expertise and to have that long-term impact.

Julie James AC: Diolch, Sioned. Those are a very good set of questions. And one of the things that we absolutely must address—and that's why I'm saying that this is both a short, a medium and a long-term aim, because we have to both be able to sustain the service, as we have it now, we have to be able to transform the service, and then we have to change it into to the upstream preventative service that we want. And we're doing that incrementally at the moment against one of the worst situations we've faced ever. Because what we've done in Wales since the pandemic is we've uncovered the hidden homelessness that we probably knew was there but we had no statistics for. Now it's out there in the open, we know what we have to deal with, and we know how much money that's going to take. We have to all pull together to do that. And there are a whole range of things in your question that I sadly won't have enough time to go into, but, clearly, housing supply, diversity of housing supply, access to housing supply, access to land and so on are all caught up in that. We have, of course, policies—some in the co-operation agreement and others not, but I'm sure are shared across the piece—to do all of those things.
Somebody asked me and I probably didn't answer it adequately, but it is about getting the right house into the right place, in building it as well, isn't it, and the right kind of accommodation. So, amongst the things I did in Newport this morning was I looked at some of our Transforming Towns funding, which you might think has nothing to do with homelessness, but, actually, a lot of it's been used to bring into beneficial use, into residential use, the space above shops, above commercial premises. So, if you walk through Newport now—and, Siân, I know you did that, too—it's quite transformed, because you've got footfall there, but you've got people living in what were just unused offices or storerooms, I guess, above commercial premises. So, that kind of innovative thinking, in a funding stream that's nothing to do with homelessness or housing, is actually also contributing to it. And what this White Paper is fundamentally about is exactly that. It's about asking people to think, when they're looking at other schemes: what can you do to contribute to this agenda, what can you do in delivering your service, to actually make this situation better. So, I think that's one good example.
The other thing is—and this is a challenge for me, and it's a challenge to all of us—I do think that the cyclical way that we do funding is driving some of the problems that we have. So, it drives some insecure employment, it makes it difficult for people to have careers and settled lives, even in the sector that's supporting people. We have not been able to come up with a better model than that. If you've got any ideas, please tell us what they are. Every time I speak to the sector, I say, 'Come up with a different model. Find me a way to fund this that isn't a cycle of grants and schemes', because that is definitely driving it. I don't have the answer; I wish I could find that answer.
And then the last thing, of course, if you can't fundamentally address the welfare issues, which are really fundamental to this, is to just maintain, at the very least, the funding that we have. So, we have done that. Oh, I wish I could have increased the housing support grant—we struggled to keep it where it was. But we did keep it where it was, and, actually, I do think that—. Well, it's quite clear that, in England, for example, there's been a 60 per cent cut in it. So, we have struggled to do that. It's not good enough—the sector could do with more, and goodness knows they could do with the recognition that comes with that. But I'm very pleased that we even managed to keep it where it was. So, that was, just to remind you, a £40 million increase in 2021-22 over what it had been before; we managed to keep it there, in the face of the worst budget settlement we've ever had, to be clear. I'm determined to do that again to the next budget settlement, to make sure that, at the very least, we can maintain what we have while we put in place all of the things that we know will prevent this spend having to be made in the foreseeable future.

I thank the Minister.

4. Debate: 'NHS in 10+ years: An examination of the projected impact of Long-Term Conditions and Risk Factors in Wales

The following amendment has been selected: amendment 1 in the name of Heledd Fychan.

Item 4 is the Government debate on 'NHS in 10+ years: An examination of the projected impact of Long-Term Conditions and Risk Factors in Wales'. I call on the Minister for Health and Social Services to move the motion—Eluned Morgan.

Motion NDM8372 Lesley Griffiths
To propose that the Senedd:
1. Notes the report from the Chief Scientific Adviser for Health on ‘NHS in 10+ years: An examination of the projected impact of Long-Term Conditions and Risk Factors in Wales.’
2. Welcomes the report findings that will assist to support future policy making under 'A Healthier Wales'.

Motion moved.

Eluned Morgan AC: Diolch yn fawr. I'm really pleased that we're taking the time today to continue the important discussion about the future of our health and social care services in Wales. When we celebrated the seventy-fifth anniversary of the NHS in July, I made it clear that the current demographic, economic and societal challenges facing our health and care system in Wales, including increasing demand on our services, is not sustainable in the current context. We know that, as part of our intention to ensure the system can be fit for the future, a serious conversation with the public about future expectations and potential reforms is required. We must continue to rebalance the system towards prevention and community-based health and social care, as well as making sure our services are used wisely, recognising that, every time we use the system, there's a cost.
On 22 September, the Chief Scientific Adviser for Health published a report describing the challenges the NHS in Wales is likely to face over the next 10 to 25 years. The report showed the likely trajectory of some long-term conditions and risk factors and how this will impact on our health and care services, as we continue to support people to live long and healthy lives. Importantly, whilst commissioned within Government, this is an independent report, which took on board analysis, including projections of our population and NHS workforce supply. The report also considers economic factors and technological advances, such as artificial intelligence, bringing it all together to inform the key policy implications arising from the detailed findings. I want to welcome and thank the chief scientific adviser for his report.
There are of course many factors that affect health outcomes, and the paper is therefore not exhaustive. But the findings will provide a significant evidence base to support our policy development and service planning going forward. It will also support the difficult decisions that we need to make here in Wales in the light of all the current challenges being faced by health and care systems across the entire world. The evidence contained in this report, taken together with wider evidence, from a range of respected and independent sources, gives us a valuable opportunity to examine the Wales-specific challenges and take stock in this seventy-fifth anniversary year of our NHS. We know that Wales has an ageing population, and it's estimated that almost one in five people in Wales will be aged over 70 by 2038—that's probably most people in this Chamber. A growing and ageing population, along with increasing numbers of people with multiple long-term health conditions, mean that pressures on the Welsh NHS and our social care system will keep rising. And we know that these pressures are building at a time of incredible economic constraint and greater public expectation as a result of advances in medical technology.
As we look towards the future, we must protect the fundamental principles upon which our NHS was created, whilst understanding that we'll all need to rise to the challenges that lie ahead. 'A Healthier Wales', our 10-year plan for health and care, was launched in 2018. It was developed in response to the 2017 parliamentary review, which stated that a 'once for Wales' approach should be developed. Our vision for 'A Healthier Wales' was a new system that would address what care would look like in the future, address the needs of the population, take, crucially, a preventative approach, be structured around the needs of the individual and delivered as close to home as possible. Now, I fully recognise the need to continually assess whether our strategic policy direction for the health and care system in Wales is right. I've, therefore, continually monitored the progress of 'A Healthier Wales' since becoming Minister for Health and Social Services.
In 2021, my predecessor reviewed and revised the original 40 actions to consider the impact of the pandemic. A new delivery plan covering the period 2021-24 was developed, with 26 revised actions. That review showed that 'A Healthier Wales' remained relevant. Our vision for an integrated health and social care system with seamless services that continue to focus on prevention and community-based care, going to a hospital only when needed, is the right one.
And whilst the report published by the Chief Scientific Adviser for health validates the policy direction set out in 'A Healthier Wales', with a focus on prevention and addressing health inequalities, I recognise that the time is right, in the light of the very latest evidence, to ensure our delivery plan remains effective against the challenges we know we're likely to face over the coming years. And that's why today I'm announcing my intention to review the current actions under 'A Healthier Wales' and examine whether there are areas we need to strengthen as we prepare for the future. I've asked officials to consider the policy implications from the chief scientific adviser's report and to ensure that we're able, within the context of the financial pressures we face, to respond to those challenges.

Eluned Morgan AC: I fully recognise that the health sector and care sector will not be able to tackle these challenges alone. There are many factors that influence people living longer lives and healthier lives. We know that good-quality housing, education and tackling poverty are vital to support healthy ways of living and sustainable ways of living. The review of 'A Healthier Wales' will therefore take a cross-governmental approach. I have asked my officials to review our actions in 'A Healthier Wales' by the end of March next year, with the intention of publishing a revised delivery plan that considers the latest evidence. Our focus on prevention and early intervention will continue, and that is vital to allow and support the people of Wales to live longer and healthier lives.

Eluned Morgan AC: I thought it was very interesting to note that, today, Keir Starmer again is following the Welsh health direction, saying that he wants an NHS that prevents illness, not just a sickness service. Well, he is welcome to take a look at our strategy, 'A Healthier Wales'. We've been at it for a few years, and it was good to see that, last week, he also said that he would be introducing a teeth-cleaning programme for children, following, once again, our Designed to Smile programme.
Now, our commitment under 'A Healthier Wales' to addressing the ongoing challenges ahead will continue, and I remain absolutely committed to, importantly and crucially, reducing health inequalities, to building more responsive primary and community planned care services, including emergency care, creating effective and supportive mental health services, supporting and developing more effective and efficient hospital services, supporting enhanced integration between health and social services, supporting and building a resilient workforce, and providing accessible digital services.
Now, turning to the amendment tabled by Heledd Fychan, the future of our Welsh NHS is entirely dependent on our workforce. This has been at the core of our approach and is central to 'A Healthier Wales'. We remain committed to work in social partnership to deliver on our national workforce implementation plan and on the non-pay elements of this year's pay deal. You'll see, over the coming weeks and months, the outputs from the joint working groups established to look at things like flexible working and continuing professional development. The pay uplift for 2023-24 has already been implemented for NHS staff.
To conclude, there are many things on which the scientists, NHS staff and the majority of this Parliament can agree. The future of our NHS absolutely depends on a strong social care service, a shift to prevention, making the very best use of the latest technologies and an ability to invest in our health and care workforce. And to make that a reality, we need a Government in Westminster that shares this ambition, one that recognises and invests in an NHS and a care system rather than choking that investment in preference for tax breaks for the wealthy. But we also need to recognise that the challenges facing our public services and our economy are real. We need to focus our spending on those things that make a difference, not on widespread NHS reorganisations but on those service reconfigurations that deliver the very best specialist care, deliver value and deliver improved outcomes. We need to ensure that public money is directed to the things that make the most difference to people in their local communities.
I also want to ask the public to play their role in relation to supporting the NHS for the long term, so it can become a sustainable institution. We can all consider what more we can do to look after our own health: eating healthily, not smoking, keeping fit. I would urge the Welsh public to think about what more they can do to ensure the sustainability of the NHS in Wales. And we'd also urge the public to participate and to give their views on the consultation that is being undertaken by the Bevan Commission and Llais on what future NHS services should look like in Wales. Diolch yn fawr.

I have selected the amendment to the motion. I call on Mabon ap Gwynfor to move amendment 1, tabled in Heledd Fychan's name.

Amendment 1—Heledd Fychan
Add as new points at end of motion:
3. Believes that if the Welsh NHS is to be safeguarded for future challenges, retaining the current workforce and recruiting more staff is essential.
4. Calls on Welsh Government to:
a) ensure that health and care sector workers receive the pay uplift they are due alongside fit for purpose working terms and conditions, including flexible working practises and in-work training opportunities; and
b) develop a clear delivery strategy with targets and full costing for a new workforce plan, including steps to remove profit from agency working.

Amendment 1 moved.

Mabon ap Gwynfor AS: Thank you very much, Dirprwy Lywydd, and I move amendment 1.

Mabon ap Gwynfor AS: And I will speak to that amendment and talk about workforce pressures, but I will also talk to the original motion and the preventative element too. Plaid Cymru has been clear from the outset that the NHS is nothing without its legions of dedicated and diligent staff. But, as we've witnessed over recent years, the NHS workforce in Wales is in a state of existential peril, with little evidence that this Government has the ability to turn the desperate situation around. It's been so heartbreaking to observe the many trends that have been developing over some time, which are increasingly showing that the Welsh NHS at present is simply not an attractive place to work, with existing staff leaving in their droves due to to workplace pressures and insufficient numbers of medical students taking up careers in the NHS.
For example, a recent Audit Wales report shows that there are currently 6,800 vacancies in the Welsh NHS, including a shortfall of 2,717 registered nurses. We also have the joint lowest level of registered doctors relative to population in the UK. Part of the problem in this respect is the low levels of retention amongst our student cohort. Fewer than half of General Medical Council-registered doctors who originally trained in Wales have remained in work in Wales. What is particularly troubling in this respect is that while our dependence on the health service is inevitably going to increase over the coming years, as we heard from the Minister, particularly due to our ageing population and our high rates of disability relative to the rest of the UK, all the current signs point towards the capacity of the NHS workforce contracting for the foreseeable future.
For example, Wales currently has an oncology vacancy rate of 11 per cent, with 80 per cent of these vacancies having remained unfilled over six months. Such trends are projected to leave Wales with a 41 per cent shortfall in oncology staff within the next four years, the highest by far of all the UK nations. In the absence of an effective strategy to get to grips with these recruitment problems, eye-watering sums are being spent on agency staff to plug the ever-widening vacancy gap. A record £325 million was spent on agency staff across the major health boards during the previous financial year, surely the most expensive sticking plaster in the history of our health service.
We all want to see a resilient, well-functioning and dynamic NHS that is able to respond effectively to the challenges of today and tomorrow, but it's about time that the Welsh Government wakes up to the reality that without urgent, radical and far-reaching action to address these long-standing issues in the workforce, our NHS simply won't exist in 10 years' time. So, I hope, during this debate, that the Government will provide a timetable and give us assurances that the agreements that the Government came to over the summer period with the unions, such as the Royal College of Nursing, and the commitment to 36 hours, will be respected.
Moving on to the preventative elements, another theme that is clearly articulated in the report is the importance of a holistic and proactive preventative agenda that acknowledges the intersections between health and wider societal issues. At the Plaid Cymru conference over the weekend I was pleased to speak with Obesity Alliance Cymru, who informed me that without urgent action to combat rates of obesity in Wales, it’s likely that the NHS will be facing additional costs of £465 million in 2050. We also need to ensure that policy making on health is receptive to the link between the prevalence of poverty, particularly amongst children, and physical and mental well-being. Though the recent publication of the long-awaited child poverty strategy is to be welcomed in that respect, it’s essential that the accompanying objectives are not pursued in isolation to broader health delivery plans.
Long-standing issues in our housing sector are also contributing to poor health outcomes in Wales. We’ve already discussed the issue of homelessness earlier, and the Minister referred to this in her opening remarks, but given the acute paucity of affordable housing for low-income individuals, it is sadly unsurprising that rates of homelessness remain high. For example, a recent Bevan Foundation report has shown that, in February of this year, only 1.2 per cent of private rented properties in Wales were available at or below the current local housing allowance rate. As we approach the colder winter months, there also needs to be serious consideration of a wide range of welfare relief measures to protect the most vulnerable in our society. A recent Public Health Wales report has found almost a third of excess winter deaths in 2022 were caused by cold housing conditions, and with energy prices remaining stubbornly high, it is likely that this winter will present even greater challenges in this respect.

Mabon, conclude now, please.

Mabon ap Gwynfor AS: I will now, diolch. Health policy in Wales cannot afford to be limited to front-line services. It must be holistic in its dimensions and fully integrated within every facet of the Welsh Government's devolved responsibilities. Diolch.

Russell George AC: Thank you, Minister, for bringing forward this debate today. I have to say, it's a really worthy debate to have. It's a very good use of business today, and I think I've put on record my own thanks to Dr Orford as well for his very, very comprehensive report. I think this report, as I see it, isn't just to the Welsh Government; it's to all of us that have an interest in bringing forward health policy in Wales.
I've picked three subject areas to focus on today: workforce, prevention and data. There's so much in this debate that I almost think it needs a series of hour debates, actually, so I'm going to go away and consider some Welsh Conservative debates on the back of this report. I think there's so much to get into. I won't have time to mention everything today; I would have liked to have spoken more on research and development, and improvements in palliative care as well, so maybe there's a future debate where I can bring some of those points about.
The Welsh Conservatives didn't put forward an amendment today because I very much took this as a noting report—noting the report before us. But I'm very happy to support the Government's motion today, and very happy to indicate my support for Plaid Cymru's amendment as well.
So, to tackle the first subject, workforce, I think workforce shortages have got to be the biggest challenge for our NHS—not in 10 years; it's a challenge now, so it's going to be a bigger challenge if we don't deal with some of the workforce pressures that are in place now. I was very pleased that Dr Orford talked quite a bit about this in his report. One interesting point was talking about how overall NHS workforce gaps are projected to persist, so the potential value of a volunteer workforce, especially the older population, should be considered, also providing wider social benefits to the volunteer. That was an interesting point he made in his report. The report also goes on to say that:
'An overall workforce supply gap already exists for registered nurses and general practice patient care staff. This is likely to increase until 2024-25 before declining gradually by 2030-31'.
That was, I think, pretty significant. I think to meet the demands of the future, we must invest in training and recruitment of healthcare professionals. This includes doctors, nurses and other health professionals, as well as specialists in mental health and chronic disease management.
Interestingly, the UK Government is creating degree apprenticeships for medicine and healthcare science, with existing apprenticeships for nursing, midwifery and allied health professionals all set to be doubled. So, the information I have in front of me here is that by 2031, degree apprenticeships will be 22 per cent of the intake for those professions.
Now, despite apprenticeships not being available here for health professionals in Wales, I did notice, of course, Health Education and Improvement Wales launching its own workforce plan in 2020 with a promise to widen access to health and social care career development and workplace learning models. I think, from my perspective, the lack of health degree apprenticeships is already a comparative disadvantage that will only widen with increased provision across the border, so I do hope that the Government can consider adopting that policy here in Wales.
The other area, of course, is prevention—such a big issue here. I really think there's got to be a focus on younger people when it comes to prevention, in terms of bringing forward change—to make those changes in patterns, in terms of smoking, poor diet and drug and alcohol use. I think the emphasis must shift towards proactive measures that prevent the development of long-term conditions. I think we need investment in public health campaigns to promote healthy lifestyles, early detection and behavioural change—I think that's paramount. I think this is particularly, as well—. I don't like Government banning things and telling people what to do, so, for me, it's about the Government putting in the right environment as well.
I think a big focus on young people—I would like to see something on encouraging gym membership, whether it's voucher schemes or encouragement schemes for discounts for entering the gym. And, of course, there's Sam Rowlands's outdoor education Bill as well, which I really think is worthy of support, because we know that if you have a change in younger people, then that habit often remains throughout a person's life as well.
Again, there's digital health and data—I think I'm running out of time, Deputy Llywydd—

You have run out of time, Russell.

Russell George AC: Just ever so—. Can I continue for a short few seconds?

You can conclude, please—you can conclude.

Russell George AC: I'll conclude, then, by saying that the final point is around data—digital health and data. On the health committee, we're forever being told, 'Data, there's a lack'. Health professionals are being asked to input data, and there's a lot of bureaucracy around that, but that data is never captured and is never used. You need to have that data in order to plan for now and into the future as well, so I think that's something as well that the Government really needs to focus on.

Huw Irranca-Davies AC: Minister, I think quite a few of us, this year, on the seventy-fifth anniversary, have been calling for this conversation on the future of the NHS. I think we're having it, and this report is really helping with it. I'm just going to open with a few of the words from one individual, who just happens to be a constituent of mine, and that's the director of the Welsh NHS Confederation. He says:
'It’s not an option to continue on the current trajectory. We need an open and honest conversation with the public about what the future health and care service looks like and the part we must all play in our own health and wellbeing. This is not just a conversation about the NHS and health, but a conversation about what every individual, organisation, sector and government department can do to improve our chances of living healthier lives and to meet the needs of future generations.'
He's right, and it's quite interesting, because this report is stark, but it's not unexpected. We knew that this was coming, but we've started to put in place already the ways in which we can respond to it. The Minister rightly picked up earlier on the issues of—and it's picked up in the motion there—'A Healthier Wales'. Okay, I've always regarded that as a live document that we should refresh, review and keep moving. But the overall approach that it painted was the right approach, and this was, what, three or four years ago. It was slightly knocked off course by the pandemic. We now need to get right back on board, but it's not just about having a live strategy that we keep on refreshing and working with the evidence; it is about delivery. Because the sort of—and we over-use this word too much—transformation that that document talks about means actually shifting money into different parts of the system, shifting responsibility, not away from primary care but more equally onto preventative care, primary care, community care and the individual, like me—I'm 60, 61, I can't remember now; I'm getting on a bit, but—onto myself as well. So, I take some responsibility—. I know, thank you, thank you. [Laughter.]
So, 'A Healthier Wales', I think, is the right framework to actually do this, but we do need to focus on the delivery of that, and the Minister will know, within that document it talked about bringing together all the sorts—. We haven't got infinite funding, we've got finite funding. I've talked to her, I mentioned to her in a meeting earlier today the fact that we need to use the funding that is available to work cleverer, and to integrate as this report and this motion hints at, and as 'A Healthier Wales' said, so that we use the money that is going to different parts of local authorities and health boards to actually deliver that person-centred individualised care from cradle to grave, as Nye Bevan and those who established the NHS said. But that means thinking differently and not fighting over budgets, but actually pooling budgets and then saying, 'Let's look at Huw, Jeremy, Katy, whoever, and let's work around them and actually deliver it, all the way there.'
Let me just pick up on a couple of points in here, because first of all it talks about providing this integrated primary community social care system. Absolutely, yes, whatever the Minister needs to do to deliver that, she will have our support in doing it. And I know, there's really great work going on out there, but I think one of the other things that this report suggests is, when we know what works, let's just get on and do it. This 'once for Wales' approach, which we've talked about before. If it works, it works, let's roll this out and actually deliver it, and stop constantly innovating to see, 'Oh, it works there, and it works there, and it works there, let's throw some more money at it to see if it works there.' Do it 'once for Wales', let's get on at that integrated, Canterbury approach as it was known before we got to 'A Healthier Wales' there. Evidence-informed policies, my goodness, how much we need that, but again, once we see the evidence, work on it, action it, deliver it.
Working with people on behavioural insights. We know that one of the biggest challenges is people like me and others trying to persuade people, particularly the classic paradigm of the most disadvantaged communities having some of the worst environmental factors, but also lifestyle factors. What is the intelligent stuff that we have that can nudge people towards packing in the smoking, packing in the bad diet and also investing in their wider environment, their housing et cetera, et cetera, so that they don't need to wash up in an accident and emergency ward, don't need to wash up in an emergency care bed, but, actually, we look after them there. So, those behavioural approaches are key as well there.
And just a couple of other things, the first 1,000 days of life is picked up in this—we know this works. That's why in Wales we invest in Flying Start, why we invest in wraparound family approaches, and we need to think cleverly about how we, with finite resources, keep on investing in those areas rather than always demanding new, fresh thinking. We know what works. The 'once for Wales' approach I've mentioned, and I'll finish, Dirprwy Lywydd, as I've run out of time, by coming back to saying, yes, refresh, review 'A Healthier Wales', but let's get on with delivering it, and we will really support you, Minister, if you push hard on this and work with partners. But that is the model: an integrated, healthcare system all around, focused on the individual. Diolch yn fawr.

Jane Dodds AS: Like many in the Siambr this afternoon, I echo your thoughts. It is a really important report that actually helps us to look at the future and brings together all of the key issues. It focuses on how, particularly, as we've heard, health inequalities cascade through generations unfortunately, inflating our costs within the NHS and also within society. And I just want to focus on those two issues, really, firstly on health inequalities, but how that also links into a topic we talked about in First Minister's questions, which was about smoking, as well. 
So, the report reveals stark and alarming disparities in life expectancy between the most and least deprived groups in Wales. I know we talk about this, but it is stark and shocking that there is nearly 10 years difference between us—brought up in, and living in fairly well-off areas—and the poorest in our society. We have a life expectancy of around 82 years—so, you've got a bit to go, Huw—and the poorest in our society live to around 73.6 years. Let's just pause and think about that: 10 years' difference, based on whether you are rich or poor. Across the UK, actually, compared to other countries on life expectancy and the disparities, we were seventh compared to our equivalent countries, and we're now twenty-ninth. So, it's getting worse.
One of the things that I know has been discussed here in the Siambr, but I think is still important, is income levels. I'm going to just make a quick case again for a universal basic income that gives us the income floor that means that people can afford to buy food, can afford to buy essentials. And that surely means that our NHS and our social care services will be saving money.
Secondly, in the time I've got left, I want to just highlight the issues around smoking. Again, Russell spoke around that, particularly smoking amongst our young people. There's a likelihood of many long-term conditions from smoking, as we know, including stroke, peripheral vascular disease, dementia, diabetes and emphysema. It is also—and this surprised me—the top risk factor for cancers, which are the leading cause of disease burden nationwide. An additional issue that I didn't realise was that the Royal College of Psychiatrists analysis showed that over 26,000 adults with severe mental illness die prematurely each year from physical illnesses exacerbated by their higher likelihood of unhealthy behaviours like smoking. Around 1,500 of these preventable deaths occurred in Wales alone.
If we truly wish to reduce the future burden on our national health services, tackling smoking prevalence must be a top priority. In particular, we should focus our efforts, as we talked about in the earlier session, on youth smoking rates. The data shows that 4 per cent of adolescents still report smoking at least weekly or daily, with no progress made on that since 2013-14. And most troubling is the fact that 58 per cent of youth smokers tried their first cigarette at the very vulnerable age, I think, of just 14 or 15, and in many cases, it's much, much younger.
As we heard this afternoon, New Zealand passed the landmark legislation banning the sale of tobacco products to anyone born after 2009 as part of their ambitious smoke-free 2025 goal to reduce smoking rates to below 5 per cent. This bold action sets us an example that we should follow. I know that we heard from the First Minister today around his support for Rishi Sunak's position in taking forward this potentially within the UK. So, I'm just really interested, Minister, if you could comment on that and whether the Welsh Government would consider following the UK Government's lead in exploring tighter regulations on youth smoking and access, and also comment on our health inequalities and how poverty affects life expectancy in Wales. Diolch yn fawr iawn, Dirprwy Lywydd.

Altaf Hussain AS: Our NHS is the ripe old age of 75—almost as young as me—but unlike me, it is starting to show its age. [Laughter.] All jokes aside, it is clear that the NHS can't continue business as usual.
The 'Science Evidence Advice' document sets out the challenge facing the NHS of 2024 and beyond—demographic changes, the increasing number of people with long-term conditions and widening health inequalities. But none of the information provided by the chief scientific adviser is new. We knew all this back six years ago, as Huw said, when Dr Ruth Hussey published 'The Parliamentary Review of Health and Social Care in Wales'. What has changed in those intervening years is the outlook of the NHS. The pandemic has cast a long shadow over our health and care system. The impact of COVID will take years to mitigate. Who knows how many people will have long-term health needs due to the fact that their diagnosis and treatment were delayed because of COVID-19?
The SEA report highlights the number of people living with musculoskeletal conditions in Wales, nearly a third of the population. We also know that orthopaedic waits have quadrupled over the past 10 years. On Thursday, I received a letter from Swansea Bay health board informing me that the waits for a knee replacement are currently at 239 weeks—not days, weeks; four and a half years. Those patients will be forced to wait, undoubtedly leading to a greater loss of function, impacting patients' health, both physically and mentally, as well as increasing the probability of the need for longer term care.
Not only is this a human rights issue, but if you look at it in simple economic terms, delayed treatment causes the NHS more in the long term. In England, the UK Government has said patients forced to wait can access private treatment, but here in Wales, political dogma prevents such an approach. Yet the private sector is the backboneof our NHS. Without the private sector, we would have no primary care. Until we have a fully staffed NHS, we have to utilise every available avenue, whether that is public, private or third sector.
The problem with our NHS is a lack of leadership and abject failure by the Government to properly plan for the future, to have a clear workforce plan. But the Welsh Government would have us believe that this is a funding issue, despite the fact that we spend more per head on health than they do in England, yet we have worse outcomes and longer wait times. But with their usual smoke and mirrors, they point to spending per head across the Bristol channel, but they are not comparing apples with apples.
Ever since Sir William Beveridge published his report in 1942, our NHS has been a single-payer system, wholly funded via general taxation. Across the continent, and, indeed, most of the world, healthcare systems are multipayer, predominantly funded via private health insurance. So, if we are going to spend more on health, we either have to dramatically put up taxes or abandon the Beveridge model of single-payer healthcare. But I don't believe we need to do either. We just have to have a better leadership, one with a workforce plan fit for the future. Only then can we serve our patients and ensure our NHS is around another 75 years. Diolch yn fawr.

Vikki Howells AC: This is a really important report, assessing what the health needs of our nation will be after the next decade, how we as a country, we as policy makers and our most treasured national institution, the NHS, are able to meet the requirements of current and future citizens. As the report reminds us, these challenges are stark.
From one perspective, the NHS is almost a victim of its own success with our ageing population. In 2023, almost one in five people living in Wales was aged 70 or over. As a comparison, the UK figure for 1953, just five years after the creation of the NHS, was around one in 14. But there are huge differences in life expectancy across the UK and within Wales based on economic affluence, as other speakers have already alluded to. It is simply unacceptable that, as the report states, the difference in life expectancy between the most and least deprived deciles is almost 10 years. Also, as people are living longer, anageing population will mean a higher proportion of the population living with long-term health conditions, and not just living with long-term conditions, but living for longer with increasingly complex needs. All are key challenges we need to consider to ensure our NHS can remain fit for purpose.
I consider there to be three key pillars that we need to address to ensure that this is the case. Firstly, and again as other speakers have already alluded to, we need to ensure that we take measures to enhance the health of the population. This starts with taking those measures to deal with relative income poverty that will tackle some of the inequalities I mentioned earlier; genuine targeted measures that work at all levels of Government and lift people up. The lost decade of Tory UK austerity and the miserable decisions that have been taken by the UK Government over the past few years have impacted on our ability to do this, and created a climate where investing in policies to enhance the wealth and well-being of the population before they become ill is considered a nice-to-have, rather than an essential pillar to secure the future viability of our national health service. I do welcome the targeted approaches from the Welsh Government and my own local authority of Rhondda Cynon Taf to try and narrow the relative income gap. It also requires that the NHS and all our society work together to take appropriate public health interventions. For example, there is the fact contained in the report that obesity levels—which are already creating a huge strain on the NHS—are expected to rise further. And conversely, while adult smoking trends have decreased, I am increasingly concerned about the take-up of vaping by children and young people who have never smoked. Both need addressing.
The second pillar to ensure the future of our health services is about ensuring NHS services are able to diagnose and treat people when ill health arises. I appreciate there are challenges here, and I'm sure—like all colleagues—this is one of the issues with which we are all only too familiar in terms of our casework. That said, I do welcome measures Welsh Government has taken within the financial stranglehold placed upon it by UK Government underfunding. I was pleased to be able to visit the site of the new Llantrisant health park in Cwm Taf Morgannwg health board area. This diagnostic and treatment centre is Welsh Government funded and will make a real difference to the ability of my constituents and those from across the area to access services, with a projection of not just being able to cut waiting lists for orthopaedic surgery, but even eliminate them within just a few years. These ambitious plans show that by reimagining the way that we configure our health services, by thinking outside the box and doing things differently, we can exact real change. I also think this development is a symbol of the Minister's commitment to providing the right services at the right place and at the right time for patients. The project is also an excellent example of the kind of collaborative working between local and central Government and across health boards that we should be encouraging.
The third and final pillar needed for the future success of our NHS in my opinion, and especially in view of our ageing population, is that we must ensure robust support is in place for people after they access NHS treatments in order to rehabilitate them, and to relieve potential further pressure on services in the long term. To give the example of stroke services here, although other core issues can apply to many other rehab services, I recently met with the Stroke Association to discuss their life-after-stroke service, ensuring that the NHS continues to work with the third sector and charities so that people can recover and live full lives, investing in services to bring them back to the very best health outcomes after they've been discharged, an investment that can again add further benefit to the NHS if stroke survivors can be helped to maintain their independence and then have to rely on the NHS and social care less. This kind of post-discharge support is really important to ensure the future viability of the NHS, and this report is a signpost and evidence base to make sure that we get things right—

Vikki, can you conclude now, please?

Vikki Howells AC: —so that the NHS remains in safe hands and adapts to changing times. Diolch.

Sam Rowlands AS: I'm grateful to be able to take part in this debate. As Vikki Howells said in opening her contribution, it's a really important debate that we have in this Chamber. Because sometimes, it can feel like we have some of the same conversations in here about our health service, so I'm pleased to be able to look beyond what's in front of us today and look at the horizon 10 years or more away. And it is frustrating that we are seeing today some of the same problems in our health service that we saw 10 years ago. Some, sadly, have even gotten worse. The pessimistic part of me leans on the old adage sometimes that the best way to predict the future is to study the past, and part of my concern today is that we're not learning enough lessons from the past if we don't take this report seriously. So, unless we see a radical change with long-term thinking from the Welsh Labour Government, then I do worry about what 10 years ahead looks like.
Deputy Presiding Officer, the Minister will be aware that I view much of the NHS in Wales through the lens of my region of North Wales, which perhaps is unfair from time to time to view NHS Wales through that lens, because we do know it's been in and out of special measures and has seen a decline in management standards for a number of years now. But with this in mind, any long-term plan, in my view, needs a sharp focus on the region I represent of North Wales, and I'd like to hear more perhaps in the Minister's response today on how this report we're viewing today will be used to specifically support change in my region. I was surprised to see in the report there was a mention of Northern Ireland and the north-east of England, but there's no mention of north Wales through the report at all—which has those serious issues with healthcare, which needs that long-term plan and also has a significantly disproportionate number of older people.
We can't avoid today the issue of long-term funding as we consider this report. It's important to remember the Welsh Government does receive £1.20 for these services for every pound that is spent in England, and the report also quotes the Nuffield Trust, who state that fact as well. And it also goes on to say that
'Welsh Government prioritised health care slightly less...than in England.'
So, it seems that some of these problems we're seeing today, and perhaps in the future, have been exacerbated by political choices here.
Of course, this is not new news to us. The report we are debating today highlights that between 2010 and 2015, health spend in England increased by 4.5 per cent, whereas in Wales health spend fell by 2 per cent, according to the Institute for Fiscal Studies. So, I'll be keen to hear from the Minister in her response today if she thinks some of these historical choices are now having an impact on our NHS in Wales and how they are going to impact things in 10 years' time as well.
Other Members have also raised the issue around how things are interlinked, and it's important to understand how things are linked between the economy and jobs, education and attainment, and how healthcare is affected as a result of those. I'm grateful to Russell George for plugging my outdoor education Bill, which, for me, is another clear example of how long-term preventative measures can be taken to improve the health and life chances of young people over a very long period of time with targeted investment. And we know that that targeted investment in outdoor education in schools pays dividends for those young people in the long run, especially in terms of healthy lifestyle and healthy choices, which support good physical and mental health. Indeed, Natural England have shown that for every £1 spent on outdoor education, it pays over £4 in social return on investment.
I started my contribution by perhaps saying that the best way to predict the future is by looking to the past, and that's the pessimistic part of my mind. But there is actually another school of thought that Alun Davies, I'm sure, will be pleased to hear about, which could be slightly more positive for us here in Wales, and this school of thought says that the best way to predict the future is to create it. So, I urge Ministers and the Government today to take this report seriously and, for the sake of the residents I represent in north Wales, seek ways in which our health service, in whatever guise it may be, is being created to support the future that is hurtling towards us. Diolch yn fawr iawn.

Alun Davies.

Alun Davies AC: I'm grateful to you, Deputy Presiding Officer. Grateful also for the tone with which Sam Rowlands completed his contribution. I actually think we need to do more than the Government is suggesting in this debate this afternoon, although I very much welcome both the report and the fact of the debate. Because when we look at our national health service, it's emblematic of much of who we are as a country. It's emblematic of the culture of our values, it's emblematic of our ambitions and our visions for the future. It was created by somebody, of course, who had no time for sacred cows. Aneurin Bevan was a creative politician because he annoyed somebody in whatever chamber he was speaking at on every occasion that he stood up to make a speech. You'll remember what Winston Churchill thought about him. It was very similar to what Clement Attleethought about him when he threw him out of the Labour Party in 1939.
To be creative isn't necessarily to accept the status quo, and to accept where we are today, and that's why I very much agree with what Sam Rowlands was saying about having to create the future. This is an excellent report, and it's a timely report, and it's an important report, and it's going to be a milestone report, because it tells us—it partly tells us what we already know, but it puts it in the context of the decisions that we have to take for the future. And this is where I believe we have to go much, much further.
When we debate obesity and when we debate the way in which we eat and the foods we consume and the rest of it, the reason we have a negative response, overwhelmingly, in that debate, is because we preach and we tell and we point and we lecture. What we don't do is listen. And we need to have a conversation about how we live our lives, and we need to have a conversation about how we want to live our lives, and the sort of lives we want our children and grandchildren to live, and that's a very different debate. It's an extremely different debate, and it's not a debate that should be about point scoring or rancour. It's a debate about listening to people on all sides of this Chamber, and accepting the challenge from all sides of this Chamber. It means asking questions about how we access primary care, of course, but it also means asking what primary care is going to be in the future, and it's asking questions about our own responsibility for our own health. It's about accepting responsibility, a personal responsibility, that it isn't up to a doctor to make us well after we've made ourselves bad. It's about having the responsibility to say that at the beginning of our lives and through our lives, we have responsibilities, and that's a conversation. It can't be a lecture and it can't be a sermon. It's a conversation that we have to have with people. But also, how then do we work with people to enable people to understand their own health and their own health issues? It's ensuring that we have a health service that is able to interrelate and interact with people through their lives, not just when they require medical support, but about taking decisions, about understanding their own health at any one time. And it's about us—and this is a really difficult decision—putting in place the structures that enable people to receive the support that they will require, and that means us asking serious questions. The market in social care today does not work. It does not deliver the quality of care that people require and we are not able to afford it.
So, how will we answer that question in the future? How will we do that? The easy thing to do, and we saw this in the 2017 general election—. Theresa May made a suggestion, rightly or wrongly. The Labour Party leapt on it, said it was absolutely the wrong way to go, and it turned into a political scrum and a political fight and people tried to score political points. And in the two weeks of a general election campaign, that is always going to happen. What we need to do is to have a real debate, and not simply believe that the challenges facing the health service are simply the result of austerity over the last 15 years. There are structural issues. We weren't training enough doctors and nurses in the 1950s, the 1960s and the 1970s. We know that. We didn't have enough critical care beds in Wales long before we'd even heard of COVID. So, these are structural issues that we need to address, and we know that the workforce—. And I speak as somebody, like many people here in this Chamber and elsewhere, whose family have worked in the national health service and devoted decades of their life to the national health service. But we know that we need to invest in that workforce of the future. But we also need to have a debate that is honest about that future, and I would—

Alun, you need to conclude now.

Alun Davies AC: I will conclude, and I willconclude by saying, as Aneurin Bevan spent a lifetime slaying sacred cows whenever he saw one, we need ourselves not to have a debate about totem poles, but we need to have a debate about what sort of health service we need for the future. Thank you.

Gareth Davies AS: It's a pleasure to take part in this debate this afternoon. I thank the Government for tabling a debate on the future of our NHS in the next decade, considering long-term conditions and what that means for the people of Wales.
As a former NHS worker for 11 years, I care deeply about the future of our NHS and what that means for my constituents in the Vale of Clwyd. As you'll be aware, I have Glan Clwyd Hospital in my constituency, which experiences long waiting times for A&E, together with out-patients and fellow services, which accommodate and care for people in the Vale of Clwyd living with long-term health conditions. A criticism I would make on the tabling of this debate is that a lot of people in my constituency will be saying, 'Well, I can't even get to see a nurse or doctor now, never mind in 10 years' time', which would be an accurate reflection of the current state of affairs for people with short and long-term health conditions in Denbighshire, and it would be incumbent on the Government to manage and reflect the current crisis facing Betsi Cadwaladr University Health Board, as well as looking to the future.
Nothing I ever remark on about the NHS is to the detriment of hard-working staff who dedicate their lives to helping the most medically vulnerable people in society, and I can't thank them enough for what they do, but what staff need is the long-term ambition from the Welsh Government, and indeed the long-term sustainability of the NHS in order to carry out their duty of care into the future. Far too many times, we hear of staff burn-out and the lack of a work-life balance, and little precious time to pursue special interests that could enhance their development, which would have a positive consequential impact to the care of a patient. Instead of achieving this, staff are left firefighting copious amounts of patient backlog just to break even, let alone look at the opportunity of career development. So, it's really important that we do factor in these internal realities and gauge an ambition of breaking the glass ceiling to provide better fluidity in the workforce, which would, firstly, benefit the morale of staff and, secondly, benefit the patients in receiving the latest first-level care experience. And, of course, what comes with that is the rewarding of this hard work and dedication through fair pay so that staff feel valued and, indeed, live a full and comfortable life.
But what I would ask the Government is how this can be achieved to a satisfactory level, given the drawbacks and challenges of the 'Agenda for Change' pay scales, which replaced the old Whitley scale back in 2004, because, in effect, if you give one department a pay rise, you have to do it for everyone, to complement the integrity of the 'Agenda for Change', which I'm not arguing against, just merely highlighting the challenges behind this and the consequential financial impact this has on Government coffers. That's not a solution that I can find, as I'm not in Government, which is why I stress the importance of Ministers and health boards working together to provide the best possible environment for our patients and staff. That's why I'm happy to support Plaid Cymru's amendment this afternoon, as I believe that uplifts in pay and working conditions are achievable for the Welsh Government if funds are prioritised on this matter, rather than blowing millions on 20 mph signs and 36 more politicians here in Cardiff Bay. Where I'm happy to support Plaid's amendment, I do sense an element of hypocrisy at the same time, given they are some of the biggest advocates for the prioritisation of Government money for such projects, but I digress.
Let's make the NHS fit for today and fit for tomorrow, so that future generations can benefit from what the health service can achieve if we have the right people running it.

The Llywydd took the Chair.

Jenny Rathbone AC: I want to follow up on some of the points made by Jane Dodds about the impact of poverty, particularly on our ability to eat well. I very much welcome that the report calls on policy and legislation to create a sustainable and joined-up food system in Wales to support our population to make healthier food choices. However, although the report acknowledges our ageing population is likely to increase the incidence of dementia and some cancers, it doesn't provide the link of that to what we eat. Equally, the report calls for reducing the amount of sodium in processed food to reduce blood pressure, but is silent on the link between the rise in obesity and ultra-processed food, even though the rising graph on obesity mirrors the rise and rise of consumption in ultra-processed food over the last 40 years.
Alun Davies, this is not about pointing, because people know that they should be eating a healthy, balanced diet, but the cost-of-living crisis is making that increasingly difficult for anybody who is on a low income. The report acknowledges that across the UK 28 per cent of adults say that they could not afford to eat balanced meals—that means they knew that they should have been eating balanced meals—and other reports I've read point out that four in 10 people regularly run out of food and other essentials in Wales. So, if you're struggling to keep your head above water, and you live in a food desert, where no fresh food is available, it's very unlikely you will be using your limited resources on a bus fare to go to somewhere where you can buy fresh food. And, actually, fresh food costs more than ultra-processed food, which is laced with chemicals. So, Minister, I know you're keen to reduce health inequalities, as you've just told us, reminded us of that, but we really do need concrete proposals that will save the NHS money, and we need to start with the way we procure food in the public sector.
I note a line in Professor Kevin Morgan's report for the Welsh Government on public sector food procurement, that, in 2008, malnutrition amongst patients in Welsh hospitals was 40 per cent, compared with the UK average of 28 per cent. That's a very significant statistic 15 years ago, so, it'd be really interesting to find out what those statistics are today, because that's not mentioned in this report.
We are going to need to procure food not just on price and ignoring quality, because, if people were better nourished, fewer of them would be going into hospital and they'd be spending less time in hospital because, obviously, malnutrition is going to impact on their ability to recover.
I note the work being done by Cwm Taf Morgannwg and Hywel Dda health boards on improving food procurement, and I'd be very keen to hear more about that in a future debate. But I really think that this is an extremely important issue, and, in particular, I want to know why there was no mention of ultra-processed food as a driver of ill health.

The Minister for Health and Social Services to reply to the debate—Eluned Morgan.

Eluned Morgan AC: Well, diolch yn fawr, and can I thank Members for what I thought was a really grown-up debate? Because it's a really sobering report, and it's important that we treat it with the seriousness that it deserves.
Just a few factual points in response to some of the points made: we know we are challenged in relation to staff in the NHS. This is not a uniquely Welsh situation. The World Health Organization suggests that they think there's going to be a shortfall of 10 million healthcare workers across the globe by 2030. This is a global competition that we are in, in relation to healthcare workers. We, of course, in Wales, are employing more healthcare workers than ever before—106,000 people—more doctors, more nurses, more ambulance workers, more allied health professionals, and yet what's happening is that the pressure, as you can see from the statistics in the report, just keeps coming—more demand, more patients, more procedures—and what that means is that some of them are finding the pressure very difficult. Recruitment and retention is absolutely something that we're focused on as a Government. We are focused on reducing the number of agency staff that we use. The default position for staff in the NHS, as a result of our negotiations and discussions with the trade unions, means that, by the end of this month, a request for flexible working will be allowed and approved in the NHS. Now, that is a significant change, and we hope that that will make a difference in relation to the use of agency workers.
One of the things I think that came up in this report was the fact that we need to think differently about the kinds of people we train. So, we need people who are multiprofessional, multiskilled—so, what we're talking about is older people with far more complex cases, and they need to understand all of the different cases, not just be specialists in the way they are at the moment. So, that suggests that we have to really change the way that we're training our healthcare workforce in future, and we are certainly aware of that.
Just in relation to Russell's points on apprenticeships, there are, of course, huge numbers of apprentices in health boards. Degree apprenticeships is what you were talking about, and I think you're absolutely right: we need to do a lot more in that space. You're right, Russell, to talk about creating the right environment. So, one of the key take-homes from this report is the inequality, the issue of inequality that was talked about by Jane Dodds. It is absolutely wrong that we live in a country where the difference in your life expectancy is a difference of 10 years depending on where you live, and even more in some places. We've got to do something to address that, and some of it is about environmental considerations, and I know my colleague Lynne Neagle, in relation to the food environment, is very aware of that. My colleagues all around the Cabinet table are aware of their responsibilities in this area. You think about housing, you think about education, you think about transport—all of these things have a contribution to make in relation to us providing the right environment for people to be able to live healthily.

Eluned Morgan AC: So, absolutely fundamental to this is poverty. We have to address the issue of poverty, and, certainly, that is something, again, that we, cross-Government, are very aware of. And that's why, by the end of this year, we'll be having a health impact assessment consultation that will have to happen across Government, but also local government in future. And so everybody will have to consider what impact their new policy suggestions will have on the health of the public in Wales.
Some people won't have read the report, so I'm just going to give you some statistics, because it is so sobering that I think it's important people hear these. So, if you just think about diabetes, we know that the rates of diabetes are already incredibly high; we spend about 10 per cent of our NHS budget on it. We have about 212,000 people with diabetes at the moment. That's going to go up by 22 per cent by 2035. So, you can just imagine the costs of that. There's no more money, but we're going to have to look after these people. So, these are really, really sobering. It's amazing that, actually, the number of people who—. You think about stroke—somebody talked about stroke. There's going to be a 33 per cent increase in the number of people living after a stroke between 2015 and 2035, and they reckon, across the UK, that means that we're going to see an increase from today's costs of £25 billion to £75 billion by 2035. These are massive, staggering figures, and some of these are things that people—. There are preventative things that people can do. If you smoke, you're more likely to have a stroke. If you eat badly, you're more likely to have a stroke. So, there are things that we can all do to stop this from being what actually happens, but we all need to take our responsibility now.
In relation to data, I can assure you that we have quite a lot of data; I spend most of my life looking at data and looking at performance and how we can improve performance. I think the shift to prevention is something, as Huw set out, that is all there. It's in 'A Healthier Wales'—it's all there. We're not doing it as fast as we may be, and that's why, for example, I've ring-fenced money this year to say, 'We're taking money out because the health boards are not doing what we want them to do.' So, I'm taking it away from them and we put it into Further Faster, for example, to say, 'There's your prevention. You're not doing it, so you do it there.' And if they don't do this shift, there'll be more of that going on. And I know that's hard because, at the same time, we've got all of these acute pressures going on in terms of waiting lists and all of those other things. At some point, we're going to just have to hold our nerve on this stuff, because if we don't we won't be able to do any of those other acute things in future because it will all be taken up.
So, 'once for Wales', the Canterbury approach, we're on it. We have one system for Wales in terms of clinical pathways. I think Altaf Hussain talked about the parliamentary review; absolutely right—COVID has changed the situation, and that's why we had that revision of 'A Healthier Wales', and that's why we're going to look at it again in the face of these very, very stark and very difficult statistics and information that we have in front of us. In terms of the workforce plan, we do have a workforce implementation plan. We spend £0.25 billion a year on our workforce. And you talked about, Altaf, comparing apples with apples. Well, you can't compare the English health service with the Welsh health service if you're serious about comparing apples with apples, because the fact is we have an older, sicker and poorer population, and you of everyone knows that that makes a difference to health outcomes. So, if we're going to compare, let's compare in a way that we all understand.
We are absolutely committed to providing NHS care free at the point of delivery. Unless something changes, though, we will have to start thinking about what it is we stop offering. Now, that’s a really, really difficult conversation with the public, and we’re going to have to have that conversation very soon, which is why the Bevan Commission is starting that conversation. You’re quite right, Alun—it’s not about telling them; it's about listening. But they also have to listen. They have to understand that there is a financial envelope that we have to keep within, and we're going to have to make some tough choices, and, if people don’t change their ways, if we can’t help them to change their environment—. We know as a Government we’ve got a responsibility to play our part, but people have got to come with us on this journey. I know it’s hard. Sir Michael Marmot tells us that if you look at the number of people, the amount, the proportion of wealth the poorest people have to spend on eating healthily is huge compared to what wealthier people have to spend. [Interruption.] If you don’t mind, I’m just going to carry on, because I know we’ve got another voting session coming up.
I’d just like to finish up just by saying that, look, inequality of health is something that we have to address. If we don’t address that issue, if we don’t start targeting and shifting those resources, then these real challenges are going to become more acute, and the sustainability of the NHS will be in question. So, it’s up to all of us to do what we can. We as a Government will play our part. Individuals need to play their part, and it’s not about paying for people to go to gyms. Lots of us went out on the run this morning; it didn’t cost us anything. It is possible to do some of these things without spending money on it. Some of us do have to. I think we all have a responsibility to play our part in making sure that the NHS is there for us in the long term.

The proposal is to agree amendment 1. Does any Member object? [Objection.] There is objection. We will therefore defer voting until voting time.

Voting deferred until voting time.

5. Voting Time

Unless three Members wish for the bell to be rung, we will proceed immediately to the vote. So, the first vote this afternoon is on the debate that we've just heard, on the NHS in 10-plus years. First of all I call for a vote on amendment 1, tabled in the name of Heledd Fychan. Open the vote. Close the vote. The vote is tied, and therefore I will use my casting vote in the negative, against the amendment. And therefore the amendment falls, with 27 in favour, no abstentions and 28 against.

Item 4. Debate: The NHS in 10+ years: an examination of the projected impact of long-term conditions and risk factors in Wales. Amendment 1, tabled in the name of Heledd Fychan: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

The next vote is on the motion in the name of Lesley Griffiths. Open the vote. Close the vote. In favour 54, no abstentions and none against. Therefore, the motion is agreed.

Item 4. Debate: The NHS in 10+ years: an examination of the projected impact of long-term conditions and risk factors in Wales. : For: 54, Against: 0, Abstain: 0
Motion has been agreedClick to see vote results

6. Debate: Stage 3 of the Health Service Procurement (Wales) Bill

That allows us to move on to our next item of business, and that is the Stage 3 debate on the Health Service Procurement (Wales) Bill.

Group 1: Technical (Amendments 7, 8, 9, 10, 11, 12)

The first group of amendments is technical in nature—that's group 1. The lead amendment in the group is amendment 7, and I call on the Minister to move and speak to the lead amendment and the other amendments in the group. Eluned Morgan.

Amendment 7 (Eluned Morgan) moved.

Eluned Morgan AC: Diolch yn fawr, Llywydd. Now, before I begin talking about the amendments in this group, I thought it would be helpful to Members if I gave a little bit of background as to how I came to introduce this Bill in the Senedd earlier—

I can't hear the Minister. If we can have some quiet on her own back benches, that would be useful to the Minister.

Eluned Morgan AC: Discipline, please. [Laughter.] Before I begin talking about the amendments in this group, I thought it would be helpful to Members if I gave a little bit of background as to how I came to introduce this Bill in the Senedd earlier this year.
Now, leaving the European Union gave the UK Government the licence to do things differently when it comes to public procurement. The UK Government introduced a general Procurement Bill to provide a platform to revise and reform the way UK public bodies source goods and services. Separately, the Department of Health and Social Care, or the UK department of health for short, decided they wanted to keep open the option of carving health services out of the wider and more general procurement reforms, and to do something specific to allow them to remove layers of bureaucracy and encourage better supplier partnerships when sourcing health services. They did that via the Health and Care Act 2022 that was going through Parliament at the same point.
But, because health is devolved, the UK department of health’s approach was effectively an English-only Act, so they just cracked on with it and, using the powers under the Act, commenced the development of their provider selection regime, so that's the procurement—the health procurement. Now, this regime brings forward a new set of procurement rules to move away from the expectation of competition in all circumstances and towards a more collaborative approach for sourcing health services. On that point, I just want to be absolutely clear that what we're talking about here today is the procurement of clinical services, not general goods such as medicines or equipment. Those kinds of goods will still, by and large, be sourced under the wider Procurement Bill regime.
But, devolved or not, we have to acknowledge that the NHS services in Wales are delivered shoulder to shoulder with the English NHS in many ways, so the UK department of health’s approach is naturally going to have implications for what we do here in Wales. As such, with the proposed introduction of the provider selection regime in England, we found ourselves in a situation where health service procurement between England and Wales would soon become misaligned and facing a number of potentially negative consequences because of that. Are you still following? [Laughter.]
So, what we're doing here, via this Bill, is plugging a gap that has been created by the introduction of the provider selection regime in England. We've brought forward this framework Bill, mainly by necessity, to give us the opportunity, should we wish, to align ourselves to the UK health department’s provider selection regime in England. Because it's a framework Bill, it not only provides us with the powers to create a new regime that best suits Wales and our health service, but also it allows us to be agile and responsive to future changes here in Wales, across the border in England, or in emergency situations such as those experienced in the pandemic. So, what we want through this Bill is the ability to be able to align with the English provider selection regime if, and only if, we want to. So, this Bill provides us with the mechanism to do just that, or, should we decide, we'll also have the flexibility to go our own way, but, crucially, the powers in this Bill seek to place us in a position to do whatever is best for Wales. As an example, this legislation could make it easier for clusters to improve local services through better collaboration of GPs, dentists, third sector and small businesses to meet the needs of local communities.
We also know that formal and often complex procurement exercises can be a barrier to entry for the third sector. This Bill creates an opportunity to make changes that can remove such barriers and develop collaborative arrangements in designing the best service for citizens. But I think what's important to understand is that procurement in itself is not the sole driver here. We're about delivering on our vision, which has been set out in 'A Healthier Wales', and what we need in terms of procurement is a system that will enable us to deliver the vision that we've got: more collaborative working, making sure that we've got high-quality services that are delivered efficiently and that are focused on patient outcomes, but making sure that we also have the right checks and balances that ensure we spend the little money we have efficiently on services for the citizens of Wales. So, before we go into the amendments themselves, I hope that's helpful in terms of a recap to give a little bit of background for Members to understand why we are here today, given that the Bill is actually really quite technical.
So, we turn to the amendments in this group, which are all of a minor and technical nature. When the UK Government’s Procurement Bill went through, initially, it had a particular numbering of different sections, but as a result of amendments added or sections deleted during the course of the passage of that Bill through the Westminster Parliament, these now have different numbers. And as we will be cross-referencing our Bill with the UK Procurement Bill, we need to make sure that they now all match up. My amendments in this group seek to do just that. So, amendment 7 amends the reference to the section within the Procurement Bill that contains the power for a Minister of the Crown to disapply provisions within that Bill in relation to regulated health procurement.
Consequential to amendment 7, amendment 8 amends the numbering of the new section to be inserted into the Procurement Bill by virtue of section 2(2) of the Health Service Procurement (Wales) Bill. This new section, 120A as amended, contains the power for the Welsh Ministers to disapply provisions in the Procurement Bill in relation to regulated health service procurement in Wales. So, amendments 7 and 8 therefore ensure that the new section 120A, as amended, will directly follow the equivalent power for a Minister of the Crown to disapply provisions in the Procurement Bill. This will ensure clarity for readers of both the Health Service Procurement (Wales) Bill and the Procurement Bill.
Amendment 9 amends the numbering of a new paragraph being inserted into the UK Government's Procurement Bill by virtue of subsection 2(3) of the Health Service Procurement (Wales) Bill, also as a result of changes to numbering of relevant sections of the Procurement Bill during its parliamentary scrutiny. This amendment is to ensure that any regulations made by the Welsh Ministers using the powers under new section 120A, as amended, are subject to the affirmative procedure and, as such, may not be made unless a draft of the instrument has been laid before and approved by a resolution of Senedd Cymru.
Amendments 10 and 11 are minor additional amendments required as a consequence of amendment 9, and amendment 12 is a further minor amendment required as a consequence of amendment 7.Whilst these amendments are technical in nature, they are important, ensuring that both this Bill and the UK Government’s Bill work correctly.
So, I would ask Members to support my amendments 7 through to 12 here today.

I have no other speakers on this group. I assume, therefore, that the Minister doesn't wish to reply to her own remarks. So the question is that amendment 7 be agreed to. Does any Member object? No, no objections. Amendment 7 is therefore agreed in accordance with Standing Order 12.36.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 8 is next. Is it moved by the Minister?

Amendment 8 (Eluned Morgan) moved.

Eluned Morgan AC: Yes.

It is. The question is that amendment 8 be agreed to. Does any Member object? No. Amendment 8 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 9. Is itmoved?

Amendment 9 (Eluned Morgan) moved.

Yes, by the Minister. The question is that amendment 9 be agreed. Does any Member object? No. Therefore, amendment 9 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 10. Is it moved by the Minister?

Amendment 10 (Eluned Morgan) moved.

Eluned Morgan AC: Yes.

It is. The question is that amendment 10 be agreed. Does any Member object? No. Amendment 10 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 11. Is it moved by the Minister?

Amendment 11 (Eluned Morgan) moved.

Eluned Morgan AC: Yes.

It is. The question is that amendment 11 be agreed. Does any Member object? No. Amendment 11 is therefore agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 12. Is it moved by the Minister?

Amendment 12 (Eluned Morgan) moved.

It is. The question is that amendment 12 be agreed. Does any Member object? No. Amendment 12 is therefore agreed.

Amendment agreed in accordance with Standing Order 12.36.

Group 2: Procurement of social care services connected to health services as part of mixed procurements (Amendments 1, 5)

We'll move, therefore, to group 2. The second group of amendments relates to the procurement of social care services connected to health services as part of mixed procurements. The lead amendment in the group is amendment 1, and I call on Gareth Davies to move and speak to the lead amendment and the other amendments in the group. Gareth Davies.

Amendment 1 (Gareth Davies) moved.

Gareth Davies AS: Thank you very much, Llywydd. I, first, just want to take this opportunity to put on record my thanks to the Minister for what has been a productive period of engagement throughout the process of this Bill. My thanks also to Sarah Beasley and the Health and Social Care Committee clerks, to the team from the legislative programme and governance unit for their support, and to Tom Livesey and the Welsh Conservative group office for their hard work.
I wish to speak to my two amendments that comprise this group, amendments 1 and 5. I have brought forward these amendments to make the case I made in Stage 2 for parity of respect for social care. Whilst I understand the points made by the Minister at Stage 2, I disagree with the assertion that it would cause confusion. I appreciate that social care is present within the definition of 'mixed procurements' already, but I am not satisfied that this secures the parity of respect for social care that we seek from this Government and from the Welsh Governments of the future. Many people take issue with social care being left by the wayside when it comes to any discussion surrounding our NHS, and as we look forward to the future and realise just how substantial a role social care will play in determining the effectiveness of the Welsh NHS going forward, it is vital that those concerns are listened to, which is why I believe it is important for these details to be displayed clearly in this Act. Thank you.

Eluned Morgan AC: As theMember has set out, amendments 1 and 5 are in relation to the provision of social care as part of the proposed new health service procurement regime.I set out our policy position on the issue of the procurement of stand-alone social care services under the proposed new procurement regime on a number of occasions throughout the scrutiny of this Bill, so I don't propose to reiterate the detail of those reasons here in the Chamber today.
But in relation to amendment 1, social care services are already, as the Member accepted, included within the definition of 'mixed procurement' when connected to a health service being procured. Adding the proposed wording 'including social care' on the face of the Bill will not change this position. Were we to reference social care as a part of mixed procurement on the face of the Bill, the impression might be created that social care services are being treated differently to other goods or services under mixed procurement. As such, I feel that the inclusion of the suggested wording in amendment 1 will only serve to cause confusion for relevant authorities once the new regime is operational.
In relation to amendment 5, the detail of how social care can be procured alongside health services as part of mixed procurement will be clearly set out as part of the statutory guidance to accompany future regulations. This will include the necessary steps with which relevant authorities need to comply when implementing the proposed new health service regime. As such, I feel that amendment 5 is unnecessary.
For those reasons, I ask Members to reject amendment 1 and amendment 5.

Gareth Davies to respond.

Gareth Davies AS: Diolch, Llywydd. Thank you for your response. As I've already said, I understand the Minister's stance, but I had hoped that the very valid points in my position would have been addressed in a more satisfactory way. I do think it's vital that this Welsh Government makes it absolutely clear that social care will receive parity of respect and focus, and that compliance in this area of procurement is suitably monitored and prioritised, not just here in this legislation but also going forward too. Thank you.

The question is that amendment 1 be agreed to. Does any Member object? [Objection.] There is objection, and therefore we will move to a vote on amendment 1. Open the vote on amendment 1. Close the vote. In favour 26, no abstentions, 28 against. And therefore, the amendment is not agreed.

Amendment 1: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Group 3: Health service procurement principles and governance (Amendments 20, 15, 17)

Group 3 is next. These amendments relate to health service procurement principles and governance. The lead amendment is amendment 20, and I call on Mabon ap Gwynfor to move the lead amendment.

Amendment 20 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Thank you, Llywydd.I move the amendment.

Mabon ap Gwynfor AS: I’d like to echo Gareth’s calls at the beginning to thank everybody who’s been involved in this process, from the clerking team and the committee to the Minister and her team. Specifically within Plaid Cymru, thanks go to Rhun for leading on the discussions earlier on, and to the research team that we have with Lewis Owen and Rhys Hughes. And specific thanks go out to Haleema Khan for her work on this as well.
The purpose of this amendment is to ensure that those who are at the heart of the health service—namely the providers and users of the service—are fully engaged in the procurement of the goods and services related to this Bill. While I appreciate that one of the aims of this Bill is to streamline decision making and to remove unnecessary layers of bureaucracy relating to health-based procurement, it’s vital that this drive for efficiency doesn’t come at the expense of the interests of staff and patients alike. If the experiences of the past few years have taught us anything, it’s that efficiency is all too often invoked by politicians as a Trojan horse for privatisation, and it is essential that this tendency is nipped in the bud here in Wales.
It’s the firm belief of Plaid Cymru that our health service is nothing without its legions of devoted and diligent staff. As such, their judgement is second to none on the impact of external procurement on the day-to-day running of the NHS. Furthermore, we have consistently emphasised that the best way to boost public trust and satisfaction with our NHS is to uphold robust standards of transparency and accountability. As such, this amendment would embed these principles in legislation as a matter of good practice. We acknowledge that this may represent a somewhat unorthodox approach compared to procurement practices in other sectors, but we would argue that the sanctity of our health service, and in particular the need to erect every possible safeguard against cronyism and privatisation, justifies such extraordinary measures.
At Stage 2, the Minister argued that the best way of achieving the aims of this amendment would be to include appropriate decision-making criteria in the development of the future regulations, supported by existing public bodies such as Llais. From our perspective, we would be eager to avoid institutional duplication as far as possible, and we are therefore open to the possibility of Llais becoming the independent arbiter of how the views of staff and patients alike can inform procurement practices in the health service.
We also appreciate the advantages of building in a degree of flexibility to reflect the fact that consulting on more technical and routine aspects of procurement might not always be necessary. However, we would require firm guarantees on this front, and in this respect we would be grateful if the Minister could elaborate on how the Government would seek to involve Llais in the development of the future regulations. In the meantime, we are pleased to be moving this amendment to ensure that the interests of patients and staff are fully aligned with procurement practices.
Amendment 15 would make provision for ensuring that the procurement of health services is subject to robust independent oversight. As I’ve already discussed, a key priority for Plaid Cymru is to ensure that the powers in this Bill are not abused in the name of cronyism. The example of the UK Government’s PPE procurement scandal, with millions of pounds of public money being paid to pals of the Tory party in exchange for subpar equipment, serves as a cautionary tale in this respect.
Given the flagrant disregard of the ethics of governance in recent years, perhaps we shouldn’t be surprised at the shoddiness of the Tories’ approach, but the people of Wales deservethe very highest standards of propriety when it comes to their health service. As such, we firmly believe that a mechanism for independent oversight of procurement decisions should be explicitly included on the face of the Bill. This would clearly articulate that the relevant powers will at all times and without exception be utilised in good faith and fully in the interests of our health service and not the unscrupulous profiteers.
Finally, amendment 17 makes provisions for the principles that will underpin future health-based procurement policies in Wales. Firstly, it would create an explicit hierarchy of potential suppliers of relevant good and services, whereby public bodies are always, without exception, given preference over private bodies. In this respect, we would enshrine in the legislation a fail-safe against the prospect of Ministers, whether in this current Government or in any future Welsh Government, using this Bill to drive privatisation through the back door, as they would be obliged to exhaust all possible options in the public sector before awarding contracts to private suppliers.
As we've already mentioned in relation to some of the other amendments, it's not our intention to impose a blanket prohibition—I know, 'blanket' got some people excited there [Laughter.]—on the NHS accessing goods or services from private suppliers. We recognise the fact that, in certain situations, this may well be the best available approach for staff and patients alike. However, what we want to see is public sector options being prioritised in the first instance, as befitting for an institution that was founded as a public service. All too often, policy makers of various political hues have tended to resort to privatisation to correct shortcomings in the NHS, without properly and objectively demonstrating its relative advantages compared to other policy approaches. Simply put, therefore, this amendment would compel Welsh Ministers to show their workings when making procurement-based decisions in a clear and transparent manner.
The amendment would also introduce a series of measures to mitigate the risk of cronyism, such as limiting the amount of spending with a single supplier and regulating the duration of contracts. The scandal of the UK Government's management of PPE contracts during the pandemic is a cautionary tale of how the procurement system can be flagrantly abused without robust legislative safeguards in place. These provisions would therefore go some way to ensuring that the Westminster chumocracy is not replicated here in Wales. Public money should be awarded to external suppliers solely on the basis of the quality of their goods or services, rather than their personal connections to the governing class. This amendment would embed this fundamental principle within the legislation.
At the committee hearing for Stage 2, the health Minister indicated that provisions within existing Welsh procurement legislation would be sufficient to achieve the aims of this amendment. I would be grateful if the Minister could provide further assurances in this respect. Nevertheless, we remain convinced that the particular threats posed to our health service by the spectres of privatisation and cronyism demand a tailored legislative approach that explicitly facilitates the primacy of public-sector-based options, wherever possible.

The Minister.

Eluned Morgan AC: In terms of amendment 20, I recognise the importance of ensuring that health services meet the needs of service users. We do, however, have to ensure that we have a procurement regime that is efficient and effective, and one that allows relevant authorities to make procurement decisions based on sound evidence and in a timely manner. One of the key purposes of this Bill is to streamline decision-making procedures by removing unnecessary layers of bureaucracy. Future regulations will set out the criteria that relevant authorities will need to consider when making procurement decisions. These are likely to include a number of principles that will take into consideration the needs of service users.
In Wales, we have a new independent body called Llais, whose role is to gather the views and experiences of service users and convey these messages in order to shape health service delivery in Wales. Health bodies already have a statutory duty to have regard to representations made by Llais. I do not wish to duplicate the remit and function of Llais via these future procurement regulations. Going further than this is not likely to be workable—that is, placing a provision in the regulations to require service users to be directly involved in decisions over the award and delivery of individual contracts. That could mean adding time and costs to the relevant authorities procuring the services, potentially delaying the delivery of critical services for the citizens of Wales. This overly onerous approach would have the opposite effect to streamlining current procurement practices and could potentially increase bureaucracy. This is especially true as the current public procurement regime, namely the Public Contracts Regulations 2015, does not require that service users have to be consulted on individual contracts. This is also not proposed in the forthcoming new regime proposed under the UK Government’s Procurement Bill.
I'm committed to ensuring that service users have a voice in respect of health services, but we also need to ensure that this is balanced carefully with the need to ensure that the system is agile. That's why I believe strongly, as set out in my letter to the three committees on 30 June, that the most effective way to achieve the aims of amendment 20 is via the inclusion of appropriate decision-making criteria in the future regulations, supported by the role of Llais. I also committed in that letter to ensuring suitable cross-references to Llais and its statutory role within the statutory guidance that will accompany the future regulations under the Bill. I therefore ask Members to reject amendment 20.

Eluned Morgan AC: Turning now to amendment 15, to include provisions in the future regulations for independent oversight of the procurement of health services, the Bill currently requires that the future regulation must make provision to demonstrate that compliance can be verified. The procedures and processes on how relevant authorities will need to demonstrate and verify compliance will be considered as part of the development of the future regulations, and the accompanying statutory guidance will describe and explain how transparency will be achieved. This will include principles around oversight and how relevant authorities must act to dischargethis requirement appropriately and provide a robust framework to ensure that public money is spent appropriately and compliantly. I would also expect a number of existing independent monitoring and reporting mechanisms will be utilised to fulfil this function. Therefore, as the Bill already requires that the future regulations must make provision for the verification of compliance, I don't believe that an additional stand-alone provision on this issue is required, and I ask Members to reject amendment 15.
Finally, amendment 17, which requires Welsh Ministers to lay a statement before, and for approval of, the Senedd setting out health service procurement principles before consulting or making the regulations. I absolutely agree that consultation is important, but as I set out during Stage 2 proceedings, this amendment requires that consultation is undertaken on the regulations, and for that to be preceded by the laying of a statement for approval in the Senedd on the procurement principles of the new procurement regime. I'm committed to undertaking consultation to inform the development of the regulations and guidance to be made under the Bill, and for that reason amended the Bill at Stage 2 to place a requirement on the Welsh Ministers to carry out such consultation as considered appropriate before making regulations under section 10A(1) of the National Health Service (Wales) Act 2006. This amendment would therefore cause ambiguity around the consultation duties in the Bill.
As regulations and guidance will be developed with NHS Wales and other relevant authorities, and informed by the consultation on the operational principles, I don't feel additional processes over and above the requirement to consult, and going beyond the normal affirmative procedure in the Senedd, are necessary. Additionally, there are already existing policies and guidance in the form of Welsh Government’s Wales procurement policy statement, which sets out the core principles on how Welsh public bodies are expected to undertake procurement. The specific procurement principles suggested in this amendment will be fully considered as part of the development of the future regulations and statutory guidance. For that reason, I don't feel that providing a separate statement for agreement by the Senedd is a requirement. So, I ask Members to reject amendment 17.

Mabon ap Gwynfor to reply to the debate.

Mabon ap Gwynfor AS: Thank you very much, Llywydd. Well, very briefly, the Minister said, at the beginning of her contribution, that these amendments could increase bureaucracy. But the reality is that in not doing this, we will leave the door open for privatisation and corruption. The intention of our amendments here is to ensure that we have those belts and braces in place to prevent corruption and to prevent privatisation from being introduced. And it's disappointing to hear a Labour Government, the party of Aneurin Bevan, taking that attitude and not taking these protective steps now in order to prevent corruption and privatisation. So, if you want to take the necessary steps to prevent that in future, then vote in favour of these amendments.

The question is that amendment 20 be agreed to. Does any Member object? [Objection.] Yes, there is objection, therefore we will move to a vote on amendment 20. Open the vote. Close the vote. The vote is tied, and so I will use my casting vote against the amendment, which leads to the result that 27 are in favour, no abstentions, 28 are against, and therefore amendment 20 is not agreed.

Amendment 20: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Group 4: Impact of regulatory alignment or divergence (Amendments 2, 18)

Group 4 is next, and these amendments relate to the impact of regulatory alignment or divergence. Amendment 2 is the lead amendment in the group. I call on Gareth Davies to move amendment 2. Gareth Davies.

Amendment 2 (Gareth Davies) moved.

Gareth Davies AS: Diolch, Llywydd. My amendments in this group will guarantee the continuity of effective cross-border health services by ensuring that it is explicitly stated in regulations under subsection (1). As the case was made in Stage 2, we must ensure that the cross-border relationship is maintained for the benefit of those that live on either side of the border but receive services from the other side. I appreciate that the Minister is concerned regarding the ability to align or diverge, as and when deemed necessary. However, I do not believe that this amendment would hamper the approach as much as has been previously implied, as such overzealous concerns from the Minister serve only to the detriment of our cross-border communities. I therefore encourage Members to strongly consider this amendment.
Turning to amendment 18, which will mean the explanatory material that accompanies regulations must set out the extent to which they mirror or diverge from section 12ZB regulations, as well as the associated risks—I am happy to support it. Diolch, Llywydd.

The Minister.

Eluned Morgan AC: Diolch, Llywydd. I understand why the Member has raised amendment No. 2 on the issue of continuity of cross-border services under the proposed new health service procurement regime. Maintaining continuity of existing service levels for the citizens of Wales is vital and is one of the key reasons why we are seeking to at least have the option to align with the UK Department of Health and Social Care's provider selection regime. The Bill will seek to provide, as far as it is possible, the flexibility to safeguard against any potential issues around the procurement and continuity of services that are currently operating cross-border between England and Wales, and as such, we need to understand how the provider selection regime in England will inter-operate with our proposed new regime for Wales. I understand the publication of the UK department of health's draft regulations and statutory guidance is imminent, and once we've had the opportunity to fully scrutinise their approach, we'll proceed with the consultation on the operational principles of our proposed new procurement regime for Wales.
Our review of the UK dept of health's approach, combined with the results of stakeholder feedback from our consultation, will provide a more comprehensive picture of the potential impacts on the continuity of cross-border services. This evaluation exercise will help us develop the necessary measures, via regulations and guidance, to ensure that services are maintained. Pre-empting our evaluation and including a specific provision on cross-border services on the face of the Bill could hamper our ability to align with, or diverge from, the UK department of health's approach on the issue now and in the future. Furthermore, the amendment could raise competence issues, as it would potentially require the regulations to make provision in relation to English contracting authorities, and, obviously, this is beyond the scope of the Bill. And for this reason, I ask Members to reject amendment 2.
In relation to amendment 18, our primary policy is to provide us with the ability to align with the department of health's provider selection regime if we want, but, of course, we need to make sure it's in a manner that best suits the future needs of the citizens of Wales. As I said earlier, I believe the UK department of health’s provider selection regime draft regulations and statutory guidance are to be published very shortly, followed by our consultation on the operational principles of our proposals for Wales. On review of the finer details of the UK department of health’s proposals and following stakeholder feedback from our consultation exercise, we may take a view that there are areas or policies where we don't want to go the same way and follow the same approach as England, but if we do want to, we will, of course, have the opportunity to do that. So, that will allow us to implement a regime that is in the best interests of the people of Wales.
The statutory guidance for our proposed new procurement regime will set out the operational principles and practical differences between the new regimes. I am of the view that this is the most appropriate place to do this, as this is where relevant authorities implementing the new regime will seek the appropriate guidance. Furthermore, the guidance is the more appropriate place to include this detail, as it provides us with the flexibility to adjust and amend the future regime in Wales to react to changes made to the provider selection regime in England. Stipulating on the face of the Bill that this detail is included in the explanatory material would mean that updates would only be made following changes to the Welsh regulations. So, the proposed amendment is unnecessary. It is for these reasons I ask Members to also reject amendment 18. Diolch yn fawr.

Gareth Davies to respond.

Gareth Davies AS: Diolch, Llywydd. It's unfortunate that the Minister is willing to forego peace of mind for our cross-border communities for the sake of something that might become a slight obstacle later down the line. Those that live on the border deserve assurances and guarantees when it comes to cross-border relationship of services. It is now down to the Minister to keep us informed on the state of cross-border services going forward, and on what the Welsh Government will be doing to maintain and protect them, an issue I'm sure that our colleagues in this place who represent such communities will rightly be keeping a keen eye on going forward. Diolch, Llywydd.

The question is that amendment 2 be agreed to. Does any Member object? [Objection.] Yes, there is objection, and therefore we will proceed to a vote on amendment 2. Open the vote. Amendment 2. Close the vote. In favour 26, no abstentions, 28 against, therefore amendment 2 is not agreed.

Amendment 2: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Group 5: Operation of regulations under section 10A(1) (Amendments 14, 16, 19, 23, 25)

The next group of amendments is group 5, and these amendment relate to the operation of regulations under section 10A(1). The lead amendment in this group is amendment 14, and I call on Mabon ap Gwynfor to move the amendment.

Amendment 14 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: I formally move the amendment, Llywydd. Thank you very much.

Mabon ap Gwynfor AS: This amendment will make provisions to ensure that relevant authorities may only award external procurement contracts to economic operators that have committed to paying their staff the real living wage. Plaid Cymru is a firm supporter of the real living wage. It's a damning indictment of our unequal society that so many people are still paid below this basic threshold for a secure livelihood. Though we believe that the eligibility criteria for external contractors should cover a range of different factors, as we will discuss in a later amendment, as a bare minimum there should be accredited real living wage employers. In our opinion, this would be a highly reliable indicator of their suitability to access public funds.
We have consistently argued that NHS staff should be remunerated fairly, and in proportion to their outstanding contribution to the health and well-being of our communities. It is only right, therefore, that we have the same expectations of the employment practices of external providers. In the long term, we also hope that this amendment will incentivise the proliferation of the real living wage amongst Welsh employers operating in the healthcare sector and beyond.
Amendment 16 would include an explicit reference on the face of the Bill to the need for the procurement of external goods or services to be subject to a competitive tendering process. In addition to the provisions of the following amendment, this will provide reassurance to the Welsh public that all procurement decisions, without exception, will be underpinned by the principles of fairness, consistency and objectivity.
Amendment 19 will ensure that the process of extending external procurement contracts beyond their original term is appropriately regulated. On the one hand we fully acknowledge the fact that there will be circumstances where rolling over contracts will be advantageous. This is particularly pertinent in relation to voluntary contracts or third sector contracts, but it could be beneficial for the NHS to extend the relationship with a charity providing support on issues such as mental health, for example.
However, we also want to make sure that mechanisms are in place to prevent contracts from simply being renewed automatically in all circumstances. In line with our approach to the other amendments, we are acutely aware of the need for this legislation to ensure that external procurement practices represent value for money, align with relevant public interest criteria, and are safeguarded against the prospect of privatisation and cronyism. On this basis, we strongly believe there should be caps on the automatic renewal of procurement contracts and that every effort should be made to justify in a transparent and open manner the rationale to extend contracts, regardless of whether the case to award the contract initially was sound. This will ensure that goods or services procured externally are consistently subject to rigorous standards, as befitting a world-class health service. The amendment would also compel policy makers to consider changes in the provision of services or goods over time, which would be particularly beneficial for the promotion of third and voluntary sector suppliers.
And amendment 23 is to include a public interest test against which the eligibility of external parties for procurement contracts would be assessed. As we’ve outlined already, we make no apologies for seeking the most robust safeguards in this Bill. Our health service is too precious to be put at risk by a lack of effective oversight against the prospect of privatisation, cronyism and the misuse of funds. The experience of the pandemic, when the UK Government awarded millions of pounds of public money to private contractors in highly unscrupulous circumstances, illustrates the dangers of inadequate legislative checks in this respect. Wales could therefore lead the way by introducing a public interest test for health-based procurement practices, ensuring that contracts are only awarded externally once it can be clearly proven that they represent value for money and satisfy a range of criteria related to their social benefits. Not only will this prevent public money from being squandered through governmental incompetence and corruption, two qualities that the Tory Government has excelled at in recent years, it will also guarantee that external contractors in the private sector are held to the same standards—[Interruption.]—as those that underpin our public sector services.

Are you taking an intervention?

Mabon ap Gwynfor AS: No, we're going on quite a bit. Sorry, Gareth.
This amendment also makes provision for the performance of external contracts to be monitored and reviewed on a regular basis so that any deterioration in the quality of the goods or services that are being provided can be appropriately addressed. Furthermore, in the interest of transparency, it would place an obligation on relevant authorities to report on how each contract is satisfying the public interest criteria. Though our preference would always be for health-based goods and services to be provided directly by the NHS as far as possible, we are not blind to the reality that there will be certain situations in which external procurement is unavoidable. This amendment would therefore grant our NHS the best of both worlds—the ability to externally procure specialist goods or services where necessary while ensuring that it is insulated against cronyism and privatisation.

Mike Hedges AC: I want to speak to amendments 14 and 23. I support us paying all working people the real living wage, and I think that's something we should be campaigning for in everything we're doing. Paying people less than it's possible to live on I think is fundamentally wrong. Alongside that, I support the ending of exploitative contracts. It's pointless being paid the real living wage for three hours a week when you can't live on the real living wage for three hours a week. So, we really do need to end exploitative contracts as well as having the real living wage in there.
I support the direct provision of services by public bodies rather than outsourcing services to the private sector where workers, in terms of their salary and terms and conditions, are disadvantaged, especially in terms of their pensions, especially in terms of sick pay and especially in terms of being dealt with when they lose time through sickness; they end up being disadvantaged and badly treated. I can name some companies—I won't because I'll probably get into trouble, but there are companies, including some near my constituency, who do exactly that.
I can understand why the Minister doesn't want to put these on the face of the Bill, but will the Minister commit to considering putting the payment of the real living wage, ending exploitative contracts and that the direct provision of services by public bodies should be considered before outsourcing in any regulations or in the regulations—I can be absolutely certain of one thing, there'll be lots of regulations—within those regulations, so that we are doing what we can to stop people being paid less than the real living wage, not working many hours and not earning enough to live on? The real living wage is only part of the process; the number of hours you work is the second part of the process. And finally, I'm wholly committed to the direct provision of services, and I oppose privatisation in all its forms. It normally costs more in the long run, but it just looks good in the short term. So, will the Minister look at those regulations to ensure that we have what I think at least three quarters of this Chamber want: people working being paid a decent wage, which is the real living wage or better, but not being exploited in the hours they're working, and, equally importantly, being provided directly by public bodies?

Eluned Morgan AC: Of course, I agree with the underpinning, underlying, principle of amendment 14, that is, to ensure that workers receive payments that are in line with the real living wage. As a Government, we're already undertaking a number of initiatives to promote and encourage the adoption of the real living wage as a way of contributing to social justice, tackling low pay and in-work poverty. For example, we're working closely with Cynnal Cymru as the Living Wage Foundation accreditation partner in Wales to support the work they do in promoting the real living wage. The Welsh Government, of course, leads by example as a real living wage-accredited employer, and we have a record number of organisations in Wales, more than 500, that are already real living wage accredited. I was really pleased to hear the Shadow Chancellor, Rachel Reeves, say earlier this week that Labour would have a genuine living wage, based on the cost of living.
This Bill, however, is about the processes that must be undertaken when relevant authorities procure health services, and to ensure the functioning of the procurement of health services on behalf of the NHS. As such, this Bill is not the place to seek to achieve the intended aim of amendment 14. The scope was deliberately narrow to enable us to fast-track this Bill to avoid a gap that could cause a real problem in terms of delivery of services, and we don't want to be challenged in terms of scope in relation to this Bill. But I will commit, Mike, to certainly having a conversation around the regulations. I think people have probably noticed this is not the most exciting Bill in the world, but the excitement will come when the regulations appear. [Laughter.] That's the time when we can start having the conversations around those things. So, I can give you that commitment, Mike.
Amendments 16 and 19 seek to include provisions on the face of the Bill that the future regulations include principles for defined thresholds where contracts above a value are subject to competition, and also around the extension and renewal of contracts. Including principles for thresholds and explicitly referencing conditions and limitations around the extension and renewal of contracts in the future regulations could restrict our ability to align with the English provider selection regime regulations in the first instance and impede our ability to respond to future changes brought forward by the United Kingdom's department of health. We need to maintain the position where we can remain agile, to ensure that there is sufficient flexibility to adapt to future changes brought about by UK department of health provider selection regime regulations, and also in response to feedback from relevant authorities as and when appropriate.
Accepting these amendments would also be contrary to the aims of the new procurement regime, which is to encourage relevant authorities to form collaborations and partnerships with independent health service providers. As such, I believe the most appropriate place for consideration of these issues is as part of that very exciting thing that is to come, the development of future regulations, and statutory guidance, and once the policy position on competition and the extension and renewal of contracts in the UK department of health provider selection regime is clear. This approach will also provide us with sufficient flexibility to react and update the regulations and statutory guidance as and when required in response to changes either brought forward by the UK department of health, or as a result of operational feedback from relevant authorities. And for these reasons, I ask Members to reject amendments 16 and 19.
Turning to amendments 23 and 25, on the issue of public interest tests, with amendment 23 providing the operative provision of a new section and regulation-making power within the National Health Service (Wales) Act 2006, and amendment 25 providing a procedure for that power, namely the affirmative procedure, as with my response to amendments 16 and 19, I believe the most appropriate place to include prescriptive details around the operational principles of the proposed new regime, including criteria around public value, is within the regulations and supported by statutory guidance. I maintain that this approach provides us with the most appropriate position to allow updates to both the regulations and statutory guidance in response to changes either brought forward by the UK department of health or as a result of operational feedback from relevant authorities. It’s for these reasons that I ask Members to reject amendments 23 and 25.

Adam Price AC: I'm grateful to the Minister, and I'm following her comments very closely. These amendments are virtually identical with the amendments that were presented by the Labour frontbench on this Bill in Westminster. Can you just explain to us why is it that Labour were proposing that they were incorporated on the face of the Bill there—in this Bill—but here you're opposing the amendments?

Eluned Morgan AC: Well, it's called devolution, Adam. It's called devolution, and we decide what's right for us. What we're doing here is we're having a framework Bill. We'll have a look at what's appropriate, and it may be, when it comes to regulations, that we will want to insert some of those things that were put forward by frontbenchers in the Labour group in Westminster. Diolch.

Mabon ap Gwynfor to reply.

Mabon ap Gwynfor AS: Thank you. Well, according to what I've heard,

Mabon ap Gwynfor AS: the revolution will be in the regulation,

Mabon ap Gwynfor AS: it appears. Now these amendments—. Once again, our intention here is to prevent corruption and cronyism. I wonder if there is such a word in Welsh.

There is now.

Mabon ap Gwynfor AS: I perhaps have just created it in Welsh.
Now I agree entirely with what Mike Hedges had to say on the real living wage and the need to prevent exploitative contracts, so I look forward to seeing Mike supporting our amendments. Mike challenged the Minister to give a commitment to look into these issues in the regulations. Well, colleagues on the Labour benches, specifically in this case: don't wait for the regulations; we can introduce and deliver this now. The amendments before us can do that, so support those amendments.
It's also disappointing, as Adam said, to hear the Labour Government saying one thing here in Wales, but something entirely differentin Westminster. We see a pattern of this, as we've heard with HS2 and all of the other examples that we have, and, in addition to that, the trade unions agree and support this too. So, if you support your comrades in the trade union movement and your colleagues in Westminster, then support these amendments this afternoon.

The question is that amendment 14 be agreed to. Does any Member object? [Objection.] Yes, there is objection. Therefore, we will proceed to a vote on amendment 14. Open the vote. Close the vote. In favour 26, no abstentions, 28 against. Amendment 14 is not agreed.

Amendment 14: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Amendment 15. Is that being moved, Mabon ap Gwynfor?

Amendment 15 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Moved.

The question is that amendment 15 be agreed to. Does any Member object? [Objection.] Yes, there is objection. Therefore, we will have a vote on amendment 15. Open the vote. Close the vote. The vote is tied, therefore, I will use my casting vote against amendment 15, which means that 27 are in favour of the amendment, there are no abstentions, and 28 are against. Therefore, amendment 15 is not agreed.

Amendment 15: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Amendment 16. Is that being moved, Mabon ap Gwynfor?

Amendment 16 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Moved.

Yes, it is. Is there objection to amendment 16? [Objection.] Yes. Therefore, we will have a vote on amendment 16. Open the vote. Close the vote. In favour 26, no abstentions, 28 against. And therefore, amendment 16 is not agreed.

Amendment 16: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Amendment 17. Is that being moved, Mabon ap Gwynfor?

Amendment 17 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Moved.

Yes, it is. Is there objection? [Objection.] Yes, there is objection to amendment 17. We'll have a vote therefore on that amendment. Open the vote. Close the vote. The vote is tied, and therefore I will use my casting vote against amendment 17. Therefore, in favour 27, no abstentions, 28 against. Therefore, amendment 17 is not agreed.

Amendment 17: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Chair used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Amendment 18. Is that being moved? It's not being moved. If there is no objection to that, I will assume that amendment 18 is not moved. And so there will be no vote.

Amendment 18 (Mabon ap Gwynfor)not moved.

Amendment 19. Is that being moved by Mabon ap Gwynfor?

Amendment 19 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Moved.

Yes. Amendment 19 will be next therefore. Is there objection? [Objection.] Yes. Therefore, we will proceed to a vote on amendment 19. Open the vote. Close the vote. The vote is tied, therefore, I will use my casting vote against amendment 19. And therefore, the result of the vote is that 27 are in favour, there are no abstentions, and 28 are against. Therefore, amendment 19 is not agreed.

Amendment 19: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Group 6: Involvement of the voluntary sector and third sector (Amendment 21)

Group 6 will be next, and the sixth group relates to the involvement of the voluntary and third sectors in the procurement of health services. Amendment 21 is the only amendment in this group, and I call on Mabon ap Gwynfor to move amendment 21.

Amendment 21 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Diolch yn fawr iawn, Llywydd. This amendment would place an obligation on Welsh Ministers to actively promote the involvement of voluntary and third sector organisations in the context of external procurement practices. This would include an obligation for Welsh Ministers to issue a statement of policy to outline the practical steps for achieving this goal. Our motivation in this regard would be to ensure that profit-making companies are not the default option when goods or services have to be sought from external sources, and that the potential value of not-for-profit alternatives is appropriately reflected in this legislation. In this respect, we can counter the specious and pernicious 'market knows best' mentality that so often pervades the agenda of proponents of NHS reform, whose presence, as we know, is conspicuous in both major Westminster parties.
We firmly believe that Wales has the wealth of resources and expertise in the third and voluntary sectors that would be utilised for the benefit of the NHS. The Welsh Government should therefore facilitate this through the provisions outlined in the amendment. This would ensure that future procurement policies are always designed in pursuit of the common public good, rather than serving narrow commercial interests. As you may have noticed, this amendment has been altered slightly since Stage 2 to accommodate the concerns raised by the Minister that there will be circumstances where the third and voluntary sectors are simply not able to supply the requisitegoods or services.
We have therefore taken the feedback on board and reworded the motion so that Welsh Ministers are only bound by this duty once it has been ascertained that the third and voluntary sectors are viable options for procurement. These changes were made in the spirit of working constructively and collaboratively on this Bill. We hope the Government will respond in kind by supporting this revised amendment.

Minister.

Eluned Morgan AC: Amendment 21 requests that, prior to making future regulations, the Welsh Ministers should lay a statement of policy before, and for the approval of, the Senedd, on the promotion of the involvement of the voluntary and third sectors in the procurement of health services. Now, I of course recognise that the voluntary and third sectors play an important role in the delivery of health services in Wales. And I also agree that the changes being brought about through this Bill could and should seek to provide opportunities for the sector. As such, the sector and all relevant bodies will be included in the consultation as the regulations and statutory guidance are developed in the future. This is something we will undertake as part of the consultation on the operational principles of the proposed new procurement regime. I introduced an amendment at Stage 2 to demonstrate our commitment to do that.

Eluned Morgan AC: Additionally, the statutory third sector regime already provides for close and ongoing engagement between the Welsh Government and the third sector through biannual meetings with each Minister, plus meetings of the third sector partnership council. Therefore, I don't see the necessity to include a specific reference to include additional processes over and above existing requirements and our commitment to consult, as detailed on the face of the Bill as amended at Stage 2.
In terms of the amendment itself, while there has been a change to the drafting since it was tabled at Stage 2, it remains unworkable. Whilst you may argue that a statement would not be necessary every time regulations are made, I would disagree. Without knowing who every single third or voluntary sector provider is, and whether they would possibly be able to provide a service that is relevant to any changes being made in the regulations, we would be in a position where we would have to issue a statement just in case. This would effectively result in a statement being made every time, which removes the flexibility to be agile and responsive to change as and when required.
For these reasons, I ask Members to reject amendment 21.

Mabon ap Gwynfor.

Mabon ap Gwynfor AS: Thank you very much. It's disappointing once again to see the Government refusing to take the necessary steps to prevent corruption and to prevent any opportunities for the introduction of private companies. The intention here is to ensure that the process is safeguarded. We have listened and we have tried to adapt our original proposal. So, in that spirit, I would urge people to support the amendment.

The question is that amendment 21 be agreed to. Does any Member object? [Objection.]Yes, there is objection. Therefore, we will proceed to a vote on amendment 21. Open the vote. Close the vote. In favour 26, no abstentions, 28 against, therefore amendment 21 is not agreed.

Amendment 21: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Group 7: Consultation regarding regulations under section 10A(1) of the National Health Service (Wales) Act 2006 (Amendment 22)

Group 7 is the next group of amendments. The seventh group relates to consultation regarding regulations under section 10A(1) of the National Health Service(Wales) Act 2006. Amendment 22 is the only amendment in this group. I call on Mabon ap Gwynfor to move this amendment.

Amendment 22 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Thank you. I formally move.

Mabon ap Gwynfor AS: As a result of constructive discussions between Plaid Cymru and a representative of the Government after the Stage 2 proceedings, we are pleased to be able to present this revised amendment, which will fulfil our aim of ensuring that the consultation process underpinning future procurement practices are above board. By placing an obligation on Welsh Ministers to publish summaries of consultation responses, the Welsh public can be reassured that any subsequent Government decisions can be scrutinised in a transparent manner.

The Minister.

Eluned Morgan AC: Thank you, Llywydd. As the Member has set out, amendment 22 would place a new requirement to publish a summary of responses received to any consultation undertaken prior to making regulations under the new section 10A.
Publishing a summary of responses to a consultation is something that the Welsh Government would do anyway, as a matter of good practice, and therefore placing a requirement such as this on the face of the Bill is not needed. However, I do understand the reasons behind this amendment and therefore I am content to support it. As such, I ask that Members support amendment 22.

The proposal is to agree amendment 22. Does any Member other than the Minister object? No, there are no objections. Therefore, amendment 22 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Group 8: Compliance with the public sector equality duty (Amendment 3)

We move now to group 8, which relates to compliance with the public sector equality duty. Amendment 3 is the only amendment in the group.

Gareth Davies to move the amendment.

Amendment 3 (Gareth Davies) moved.

Gareth Davies AS: Diolch, Llywydd. With this amendment, as in the previous stage of scrutiny, I am seeking to ensure that Welsh Ministers must lay a statement before the Senedd to confirm that they have complied with the public sector equality duty in section 149 of the Equality Act 2010. As Members will be aware, those subject to this duty must have due regard to the need to eliminate unlawful discrimination, harassment and victimisation, and other conduct of a similar nature that is prohibited by the Act.
As I made clear when I first tabled this amendment, my objective here is to ensure due diligence. It also means that such compliance is at the forefront of ministerial decision making, particularly when it is not otherwise confirmed or alluded to within the Bill itself.
It should be noted that an amendment such as this is not an assertion that the Minister would in any way attempt to shirk her responsibilities in this area; it is simply a legislative safety net that serves to put minds at ease and would not nullify the effectiveness of the Act itself. And for those reasons, I do encourage Members to consider my amendment today. Diolch, Llywydd.

The Minister to contribute.

Eluned Morgan AC: Diolch, Llywydd. As the Member has set out, amendment 3 would require Welsh Ministers to lay a statement before the Seneddprior to making regulations under what would be the new section 10A, as inserted by section 3 of the Bill, explaining how the Welsh Ministers have complied with the public sector equality duty under the Equality Act 2010. This amendment is a repeat of that tabled at Stage 2, and as I set out during Stage 2 proceedings, what is not clear is the reasoning for the amendment, given Welsh Ministers are already required to comply with that duty under existing legislation. So, this would simply be a duplication.
Equally, the amendment as drafted is ambiguous, as it still doesn't clarify what is required in the statement in terms of compliance with the public sector duty. The amendment could be read to mean several different things. Clarity and certainty are needed when imposing legal obligations. For these reasons, I ask that Members reject amendment 3.

Gareth Davies to respond.

Gareth Davies AS: Diolch, Llywydd. The Minister made similar comments on the previous occasion I brought forward this amendment in committee, and I do want to make clear that I do recognise her position and the reasoning behind it. However, I do hope that she appreciates the very valid concern for a lack of a safety net on this, if for no other reason than as a reiteration of the importance of this duty for Welsh Ministers, as an assurance that it is ever-present in the legislative process in this place. Thank you very much, Llywydd.

The question is that amendment 3 be agreed to. Does any Member object? [Objection.] Yes, there is objection, and therefore we will proceed to a vote on amendment 3. Open the vote. Close the vote. In favour 26, no abstentions, 28 against, and therefore amendment 3 is not agreed.

Amendment 3: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Group 9: Interaction with the wider policy, legislative and strategic context (Amendment 4)

Group 9 is next, therefore. This group of amendments relates to the interaction with the wider policy, legislative and strategic context. Amendment 4 is the only amendment in this group, and I call on Gareth Davies to move the amendment. Gareth Davies.

Amendment 4 (Gareth Davies) moved.

Gareth Davies AS: Diolch eto, Llywydd. Speaking to my amendment for this group, amendment 4, it is as it was in Stage 2, as a straightforward amendment. It serves to clarify that regulations made do not conflict with the United Kingdom Internal Market Act 2020. I was not satisfied when the Minister claimed in Stage 2 that the amendment was not necessary, simply because she had already committed to adhering to the UK internal market Act during the general principles of the Bill. This is not something that can be left to chance or promise. It is something that must be enshrined in legislation and futureproofed for when future Welsh Governments take the helm. We cannot afford to have ambiguity or uncertainty on this issue, so I encourage colleagues across the Chamber to consider the importance of this amendment when they vote. Thank you.

The Minister to contribute.

Eluned Morgan AC: Diolch, Llywydd. In relation to amendment number 4, I made a commitment during the general principles debate to include within the explanatory memorandum that will accompany the future regulations an assessment of whether the future regulations engage the United Kingdom Internal MarketAct 2020. Having given that commitment, I don't feel it's necessary to include a provision for this on the face of the Bill, and I ask Members to reject amendment 4.

The question is that—

Oh, no. Gareth Davies, do you want to respond, sorry?

Gareth Davies AS: Diolch, Llywydd. As stated before, I'm disappointed to see the Minister disregard the risks of her approach on this. Whilst I have no doubt that the Minister has every intention of following her commitment, I strongly believe there is nothing lost in securing this commitment in the Bill itself, yet there is much to gain in the way of certainty. It is unfortunate that the Minister feels differently, and I hope that my concerns regarding this oversight do not come to fruition. Thank you.

The question is that amendment 4 be agreed to. Does any Member object? [Objection.] Yes, there is objection. Therefore, we will proceed to a vote on amendment 4. Open the vote. Close the vote. In favour 26, no abstentions, 28 against. Amendment 4 is not agreed.

Amendment 4: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Amendment 5.

Gareth Davies, is it being moved? Amendment 5, is it being moved in your name?

Amendment 5 (Gareth Davies) moved.

Gareth Davies AS: Yes.

Yes, amendment 5 is moved. Therefore, is there objection to amendment 5? [Objection.] Yes, there is objection. We will proceed to a vote on amendment 5. Open the vote. Close the vote. In favour 26, no abstentions, 28 against.

Amendment 5: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Group 10: Review of the operation of regulations under section 10A (Amendment 6)

Group 10 is the next group of amendments, and they relate to the reviewing of the operation of regulations under Section 10A. The only amendment in this group is amendment 6, and I call on Gareth Davies to move that amendment.

Amendment 6 (Gareth Davies) moved.

Gareth Davies AS: Diolch, Llywydd. I will speak to my amendment for this group, amendment 6. With this, I seek to ensure that Welsh Ministers must regularly review the operation of the regulations and publish the conclusions of the review before the end of the period of five years beginning with the day on which the regulations come into force.
I had originally tabled an amendment to this effect at Stage 2. However, the Minister made some valid points, and I appreciate the need for flexibility, with timescales for practical implications, particularly regarding synching with the DHSC’s reviews. I was therefore happy for her officials to work with my team and me to produce an improved draft of this amendment, which I hope will now have the support of the Minister and Members of the Senedd, ensuring that recommendations from the committee stage are properly seen through and that an appropriate level of accountability can be introduced. Thank you.

Eluned Morgan AC: Amendment 6 is a revised version of an amendment tabled by the Member at Stage 2. During Stage 2 proceedings, I explained that whilst I agreed with the premise of the amendment as drafted, it didn't achieve the intended outcome and therefore couldn’t be accepted. The Member has revised and retabled the amendment and, as he’s set out, it would include a new requirement to review the operation of the regulations made under section 10A, and to publish the outcome of that review within five years of them coming into force. Reviewing the operation of any new system, or procurement regime in this case, is something that should be done as a matter of good practice, and I therefore have no issue with this amendment, and I ask Members to support amendment 6.

Gareth Davies to respond.

Gareth Davies AS: Thank you, Llywydd. As you can tell, I'm beaming with joy. I would very much like to thank the Minister for her willingness to assist in the development of this amendment, and I am glad that the importance of this issue was not overlooked. Suffice it to say that it is a rather uncommon occurrence for one of our amendments to enjoy the support of a Welsh Minister, but we absolutely welcome it and are grateful that she clearly understands what we aimed to achieve here and was willing to collaborate to get this over the line. Thank you very much.

The question is that amendment 6 be agreed to. Does any Member object? There is no objection, therefore amendment 6 is agreed.

Amendment agreed in accordance with Standing Order 12.36.

Amendment 23. Is it moved by Mabon ap Gwynfor?

Amendment 23 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Yes.

It is. The question is that amendment 23 be agreed to? Does any Member object? [Objection.] Yes, there is objection. We will, therefore, proceed to a vote on amendment 23. Open the vote. The vote is tied and, therefore, I will exercise my casting vote in the negative against amendment 23. The result of the vote is that there were 27 in favour, no abstentions, 28 against. Therefore, amendment 23 is not agreed.

Amendment 23: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Group 11: Scrutiny procedure for regulations under section 10A(1) (Amendments 24, 26, 13)

The next group of amendments is group 11, and these relate to the scrutiny procedure for regulations under section 10A(1). Amendment 24 is the lead amendment in this group. Mabon ap Gwynfor to move the lead amendment.

Amendment 24 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Thank you. I formally move the amendment.

Mabon ap Gwynfor AS: All these amendments are linked together, so I will speak to amendment 26. This amendment would make provisions for a superaffirmative procedure for securing Senedd consent on any future regulations made through this Bill. As I've mentioned throughout the course of this debate, our utmost priority is to ensure that the powers contained in the Bill are not abused for the purposes of cronyism or pushing through privatisation through the back door. A superaffirmative mechanism of this nature, while unusual, reflects the seriousness of commitments to upholding the integrity of our NHS as a public service that is free at the point of use. While I'm sure some will argue that this approach would be unduly cumbersome, from our perspective the fact that the spectre of privatisation has hung above our health service like the sword of Damocles in recent years, primarily as a result of policy decisions taken by both major Westminster parties, demonstrates the need for the most rigorous degree of Senedd oversight in this area. We've also had abundant proof in recent years of the damage that can ensue when there is insufficient scrutiny of governmental decisions—a risk against which we should make every effort to insulate our health service.

Eluned Morgan AC: All three of these amendments, 24, 26 and 13 are interlinked and essentially provide for a new super-superaffirmative procedure for the regulations to be made under new section 10A, as inserted by section 3 of the Bill.
I recognise that the power we propose to insert as new section 10A is a significant one, which is reflected by the fact that the affirmative procedure is to be applied to it. And it is further reflected by the fact I amended the Bill at Stage 2 to provide a requirement to consult before making the regulations.
But I do not agree that the procedure proposed in amendment 26 is appropriate. It would greatly add to the complexity of Senedd processes and have a considerable impact on the timely operational delivery of the new bill. The initial purpose of the fast-tracked timing of this Bill was to align with the timing of other procurement changes in order to minimise risk to health services in Wales. Whilst I appreciate that there has been a delay to the completion of this Bill owing to delays with the UK Government’s Procurement Bill, aligning as far as possible with the timings of other procurement changes remains a key objective. The primary reason for this is to minimise the significant risk associated with having a misalignment in procurement procedures for health services in England and Wales, as well as being of benefit to the relevant authorities and other organisations implementing the changes.

Eluned Morgan AC: I also note there is a resemblance to section 18 of the Legislative and Regulatory Reform Act 2006. But the power in that Act was very different from the power we are proposing in this Bill. That was a provision that gave Ministers the power, by Order, to remove or reduce burdens, such as financial cost or administrative inconvenience, resulting from any legislation. The power we are proposing to insert as new section 10A of the NHS (Wales) Act is in a very different category from that. The Senedd’s affirmative procedure is both appropriate and adequate in this circumstance, especially when taking into account the additional requirements on the face of the Bill in respect of these regulations, such as consultation and review.
This is, I'm sure you'll be pleased to hear, my last intervention—I'm sure you're very sad to hear that. But I would really like to thank you, in particular the shadow health leaders in this particular Bill, for the really constructive way I think we've worked together on the Bill. Thank you for your very constructive engagement. I want to finish by thanking the Bill team for the huge amount of work they've put into this. Their valiant efforts are very much appreciated. Diolch yn fawr.

Mabon ap Gwynfor to respond.

Eluned Morgan AC: [Inaudible.]

It's okay; I'll come to that. Mabon ap Gwynfor.

Mabon ap Gwynfor AS: Diolch, Llywydd. Before the summer recess, we had a debate in this Senedd on the 75 years of the NHS. Everybody present supported the call to keep the NHS a public service free at the point of use. One would assume that the majority here in this Siambr wanted to protect our NHS from creeping privatisation. On over a dozen occasions this afternoon, we've had an opportunity to show this core belief by introducing positive amendments to this effect in this Bill. Plaid Cymru have proposed these amendments. The Conservatives supported those amendments. But, so far, on over a dozen occasions, the Labour Party have refused to support those amendments. This is a final opportunity to ensure that we keep our NHS free, and free from cronyism, free from corruption and free from the private sector where it's unnecessary. Please support this amendment.

The question is that amendment 24 be agreed to. Does any Member object? [Objection.] There is objection. We will, therefore, proceed to a vote on amendment 24. Open the vote. Close the vote. In favour 26, no abstentions, 28 against. Therefore, amendment 24 is not agreed.

Amendment 24: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Is amendment 25 moved by Mabon ap Gwynfor?

Amendment 25 (Mabon ap Gwynfor) moved.

Mabon ap Gwynfor AS: Move.

It is. Is there objection? [Objection.] There is. The question is that amendment 25 be agreed. Open the vote. Close the vote. This vote is tied and, therefore, I will exercise my casting vote against the amendment. Therefore, the result of the vote is that there were 27 in favour, no abstentions and 28 against. Therefore, amendment 25 is not agreed.

Amendment 25: For: 27, Against: 27, Abstain: 0
As there was an equality of votes, the Llywydd used her casting vote in accordance with Standing Order 6.20(ii).
Amendment has been rejectedClick to see vote results

Is amendment 26 moved, Mabon ap Gwynfor?

Amendment 26 (Mabon ap Gwynfor) moved.

It is. Is there any objection? [Objection.] There is objection to amendment 26. We'll therefore move to a vote on amendment 26. Open the vote. Close the vote. In favour 26, no abstentions, 28 against. Therefore, amendment 26 is not agreed.

Amendment 26: For: 26, Against: 28, Abstain: 0
Amendment has been rejectedClick to see vote results

Amendment 13. Mabon, is it moved?

Mabon ap Gwynfor AS: No.

It is not. Is there any objection to that? So, amendment 13 is not moved.

Amendment 13 (Mabon ap Gwynfor) not moved.

And that concludes voting for this afternoon. I declare that we have reached the end of our Stage 3 consideration of the Health Service Procurement (Wales) Bill, and I declare that all sections and Schedules to the Bill are deemed agreed.

All sections of the Bill deemed agreed.

Thank you all very much. Good evening.

The meeting ended at 18:12.

QNR

Questions to the First Minister

Rhys ab Owen: What assessment has the First Minister made of the readiness of local businesses for the Environmental Protection (Single-use Plastic Products) (Wales) Act to come into effect?

Mark Drakeford: Since announcing our proposals in 2020, we engaged closely with the business sector to help raise awareness. This has included undertaking surveys with businesses, working collaboratively on guidance and providing communication materials relating to single-use products being banned or restricted. Many businesses have already moved to non-plastic alternatives.

Sarah Murphy: What consideration has the Welsh Government given to learner travel in the forthcoming bus bill?

Mark Drakeford: Under franchising we will be able to work with local authorities to plan scheduled bus services and school transport together to provide a better, more joined-up and more efficient service for learners to get to school.

Buffy Williams: How will the South Wales Metro electrification works benefit commuters travelling to and from both the Rhondda Fach and Rhondda Fawr?

Mark Drakeford: Electrification will provide a turn-up-and-go rail service in Rhondda Fawr. Commuters in Rhondda Fach will have easy access to the improved services via the new Porth transport interchange.

Paul Davies: Will the First Minister make a statement on improving water quality in Pembrokeshire?

Mark Drakeford: Pembrokeshire is home to 29 designated bathing waters, with 27 rated 'excellent' and two 'good'. It is also home to the Cleddau, a special area of conservation river known for its array of wildlife. Our approach focuses on multisector co-operation and nature-based solutions to improve water quality across catchment areas.